Aortic aneurysm disease vs. aortic occlusive disease - differences in outcome and intensive care resource utilisation after elective surgery

Abstract Background: Subsequent intensive care unit (ICU) admissions postoperatively are not rare for patients with abdominal or thoracic aortic aneurysm (AAA or TAA), but a large-scale investigation on these patients is absent. The study aimed to investigate the characteristics and prognosis of AAA or TAA patients admitted to ICU postoperatively.Methods: Patients admitted to ICU postoperatively with a primary diagnosis of AAA or TAA were screened in the eICU Collaborative Research Database, which contained data from multiple ICUs throughout the continental United States in 2014 and 2015. Baseline characteristics and comorbidities and were investigated and factors associated with ICU mortality were explored using univariable logistic regression. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the prognosis predictive performance of the widely used severity scoring system APACHE IVa.Results: 974 patients including 677 AAA and 297 TAA patients admitted to ICU postoperatively were included finally. Compared with TAA, AAA patients had a significantly higher median age (72 versus 64 years). 10.19% AAA and 2.36% TAA patients suffered from rupture of aortic aneurysm, and 89.07% AAA and 84.51% TAA patients underwent elective surgery. Hypertension requiring treatment was the most common comorbidity (57.31% for AAA and 61.95% for TAA). TAA patients had significantly higher ICU mortality (9.43% versus 2.36%) than AAA. Several factors were found to be significantly associated with ICU mortality, including urgent surgery, rupture of aortic aneurysm, TAA, and a higher APACHE IVa score on ICU admission. APACHE IVa showed a good predictive performance for ICU mortality with an area under the ROC curve of 0.9176 (95% CI 0.8789-0.9390).Conclusions: Prognosis of aortic aneurysm patients admitted to ICU postoperatively is yet to improve, and factors associated with prognosis are mainly related to the condition itself. APACHE IVa can be used for prognosis prediction.

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IMPACT OF PATIENT- AND FAMILY-CENTRED CARE MEETINGS ON INTENSIVE CARE RESOURCE UTILISATION IN TERMINALLY ILL PATIENTS: A SINGLE-CENTRE RETROSPECTIVE OBSERVATIONAL STUDY IN TAIWAN

Respirology ◽

10.1111/resp.13420_149 ◽

2018 ◽

Vol 23 ◽

pp. 144-144

Keyword(s):

Intensive Care ◽

Observational Study ◽

Terminally Ill ◽

Retrospective Observational Study ◽

Resource Utilisation ◽

Single Centre ◽

Terminally Ill Patients ◽

Intensive Care Resource

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miR-29c-3p is an Effective Biomarker of Abdominal Aortic Aneurysm in Patients Undergoing Elective Surgery

MicroRNA ◽

10.2174/2211536605666160901103754 ◽

2016 ◽

Vol 5 (2) ◽

pp. 124-131 ◽

Cited By ~ 7

Author(s):

Sabina Licholai ◽

Wojciech Szczeklik ◽

Marek Sanak

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Elective Surgery ◽

Abdominal Aortic

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Abstract 15129: Outcomes Related to Age of Elective Surgery and Age of Dissection Within Genetically Triggered Aneurysm Conditions: The Gentac Experience

Circulation ◽

10.1161/circ.142.suppl_3.15129 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Kathryn W Holmes ◽

Scott A Lemaire ◽

Richard B Devereux ◽

William J Ravekes ◽

Shaine A Morris ◽

...

Keyword(s):

Aortic Aneurysm ◽

Thoracic Aortic Aneurysm ◽

Elective Surgery ◽

Aortic Surgery ◽

Reference Population ◽

Ehlers Danlos Syndrome ◽

Aortic Replacement ◽

Fourth Decade ◽

Ascending Aortic Replacement ◽

Aortic Dissections

Introduction: The GenTAC Registry ( G enetically Triggered T horacic A ortic Aneurysms and Cardiovascular C onditions) followed patients with aortopathies over 8 years among 8 centers with the goal of evaluating cardiovascular outcomes. Methods: Enrollment initiated in 2007, and data were collected until 2015. We included diagnoses with >100 participants: Bicuspid aortic valve with aneurysm (BAV, n=879), Marfan syndrome (MFS, n=861), Familial thoracic aortic aneurysm or dissection (FTAAD, n=378), Other thoracic aortic aneurysm at < 50 years of age (Other<50, n=524), Turner syndrome (TS, n=298), Vascular Ehlers Danlos syndrome (VEDS, n=149), and Loeys-Dietz syndrome (LDS, n=121). We identified patients who underwent elective ascending aortic replacement, total unique dissections, and time to first dissection. With MFS as a reference population and adjusted for sex, endpoints were analyzed by a Firth penalized Cox-PH regression model to account for diagnosis groups with low event numbers. Results: LDS participants at a mean age of (24.5 ± 15.0y) were youngest at elective aortic surgery followed by MFS (32.3 ±12.3y), TS (37.6 ±13.6y), VEDS (35.0 ±SD 7.4y), Other<50 (40.3 ±SD 10.3y), FTAAD (42.9 ±14.2y), and BAV(49.4 ± 13.8 y). Dissections were reported in all diagnosis groups with a total of 472 unique dissections in 3210 patients (14%). Mean age at first dissection was in the third decade for LDS, TS, MFS, VEDS and in the fourth decade for BAV, FTAD, and Other<50. Adjusted hazard ratio for time to first dissection was higher in LDS, 1.77 (95%CI 1.14- 2.77), compared to MFS and other diagnosis groups (Figure 1). Conclusions: Reported aortic dissections were prominent in the GenTAC cohort. Despite elective surgery at a younger age, LDS patients had a higher hazard risk of dissection compared to other diagnosis groups.

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Severity and prognosis in intensive care: prospective application of the Apache II Index

Sao Paulo Medical Journal ◽

10.1590/s1516-31801999000500005 ◽

1999 ◽

Vol 117 (5) ◽

pp. 205-214 ◽

Cited By ~ 8

Author(s):

Joel Isidoro Costa ◽

José Luiz Gomes do Amaral ◽

Masashi Munechika ◽

Yara Juliano ◽

José Gomes Bezerra Filho

Keyword(s):

Intensive Care ◽

Mortality Rate ◽

Elective Surgery ◽

Tertiary Care ◽

Prognostic Index ◽

Clinical Severity ◽

Apache Ii ◽

Sample Population ◽

Significant Difference ◽

Critical Patients

CONTEXT: The performance of each ICU needs to be assessed within the overall context of medical care, as well as by the institution which the ICU forms part of. Evaluation mechanisms in the field of intensive care have been developed that are recognized worldwide within the scientific literature. OBJECTIVE: To study outcomes from groups of critical patients and to compare their actual and estimated mortality rates. DESIGN: Prospective study of patients' outcomes. SETTING: A tertiary care unit for a period of 13 months (anesthesiology intensive care unit at the Escola Paulista de Medicina). PARTICIPANTS: 520 patients selected according to sex, age and nature of hospitalization. DIAGNOSTIC TEST: The modified APACHE II prognostic index was applied in order to assess clinical severity and anticipation of mortality in three groups who had non-surgical treatment, emergency surgery and elective surgery. MAIN MEASUREMENTS: The APACHE II index. RESULTS: The application of this index allowed patients to be stratified and expected death risks for both subgroups and the entire sample population to be calculated. The observed mortality rate was greater than the expected rate (28.5% versus 23.6%, respectively), with a statistically significant difference. The standardized mortality rate was 1.20. Patients who obtained scores above 25 presented a significant outcome towards death. The most severe and worst evolving cases were, in decreasing order: non-surgical, emergency surgical and scheduled surgical patients; the actual general mortality rate was higher than the expected one. CONCLUSIONS: The use of the APACHE II index made it possible to stratify critical patient groups according to the severity of their condition.

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Surfactant replacement therapy in neonates less than 32 weeks gestation: Effect on neonatal intensive care resource utilization

Journal of Paediatrics and Child Health ◽

10.1111/j.1440-1754.1993.tb03015.x ◽

2008 ◽

Vol 29 (6) ◽

pp. 434-437 ◽

Cited By ~ 1

Author(s):

K. DIWAKER ◽

S. ROBERTS ◽

E. JOHN

Keyword(s):

Intensive Care ◽

Replacement Therapy ◽

Resource Utilization ◽

Neonatal Intensive Care ◽

Surfactant Replacement ◽

Surfactant Replacement Therapy ◽

Intensive Care Resource

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Compensated activation of coagulation in patients with abdominal aortic aneurysm: effects of heparin treatment prior to elective surgery

Thrombosis and Haemostasis ◽

10.1160/th03-10-0665 ◽

2004 ◽

Vol 92 (11) ◽

pp. 997-1002 ◽

Cited By ~ 14

Author(s):

Jacek Szmidt ◽

Krzystof Bojakowski ◽

Tomasz Grzela ◽

Magorzata Palester-Chlebowczyk ◽

Maria Jelenska

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Reference Group ◽

Elective Surgery ◽

Operation Time ◽

Fibrinogen Concentration ◽

Excessive Bleeding ◽

Prothrombin Fragment ◽

Abdominal Aortic ◽

D Dimer

SummaryElective surgery of abdominal aortic aneurysm (AAA) sometimes leads to excessive bleeding and disseminated intravascular coagulation (DIC), even in patients with normal preoperative coagulation parameters. Coagulation screen, performed routinely before surgery is of limited value in the assessment of compensated activation of the haemostatic system. In this study, we used a number of additional tests (D-dimer, prothrombin fragment 1+2, antithrombin, and activation of fibrinolysis in the platelet poor plasma) for the diagnosis of compensated activation of the haemostatic system in AAA-patients. Ddimer and marker of thrombin generation (prothrombin fragment 1+2) positively correlated with each other (r = 0.768, P < 0.001). Out of 71 AAA patients, 15 patients had normal global coagulation times, but those with a Ddimer concentration above 3000 ng/ml were selected for preoperative low molecular weight heparin (LMWH) treatment. Administration of LMWH diminished coagulation abnormalities (D-dimer and prothrombin fragment 1+2 decreased significantly) and resulted in the increase of platelet number and fibrinogen concentration, indicating their previous consumption. Despite differences in aneurysm diameters between the groups of 15 LMWH treated patients (mean 70.9 ± 16 mm) and the reference group of 20 untreated AAA patients (mean 52.3 ± 8.0 mm), intraoperative parameters (operation time, blood loss and transfusion demands) were similar.

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