The incidence of cardiovascular and other major complications after open abdominal aortic surgery

Background: Abdominal aortic aneurysms (AAAs) and peripheral artery disease significantly increase the risk of perioperative complications. Aim: To determine the incidence, association with 30-day mortality and predictors of myocardial injury after noncardiac surgery (MINS), postoperative acute kidney injury (pAKI) and bleeding independently associated with mortality (BIMS) in patients undergoing open vascular surgeries involving abdominal aorta. Methods: We performed a retrospective cohort study using a sample of consecutive patients who underwent open abdominal aortic surgery due to infrarenal AAA and/or aortoiliac occlusive disease in a single tertiary center. In each patient at least two postoperative troponin measurements were performed (on the first and the second postoperative day). Creatinine and hemoglobin levels were measured preoperatively and at least twice postoperatively. The outcomes included MINS (primary outcome), pAKI, and BIMS (secondary outcomes). We assessed the association between them and 30-day mortality and performed multivariable analysis to identify risk factors for these outcomes. Results: The study group comprised 553 patients. The mean age was 67.6 years and 82.5% of patients were male. The incidence of MINS, pAKI, and BIMS was 43.8%, 17.2%, and 45.8% respectively. The 30-day mortality was higher in patients who developed MINS (12.0% vs. 2.3%, p<0.001), pAKI (32.6% vs. 1.1%, p<0.001), or BIMS (12.3% vs. 1.7%, p<0.001) compared to patients who did not develop these complications. Conclusion: This study demonstrated that MINS, pAKI and BIMS are common complications after open aortic surgeries and are related to a substantial increase in the 30-day mortality rate