Late survival risk factors for abdominal aortic aneurysm repair: Experience from fourteen Department of Veterans Affairs hospitals

Background. This study evaluates late survival risk factors for patients who underwent elective abdominal aortic aneurysm surgical procedures performed at 14 Department of Veterans Affairs hospitals across the United States between 1985 and 1987. Methods. Preoperative risk factors for a representative sample of 280 male veterans were obtained from an extensive Department of Veterans Affairs Office of Quality Management study and subsequent chart review. The National Death Index was used to determine survival through December 1991. Results. Mortality at 30 days was 2.9%. Kaplan-Meier survival probabilities were 89% (±2%) at 1 year and 64% (±3%) at 5 years. Multivariate hazards models indicated significantly poorer survival for patients with age greater than 69 years, chronic obstructive pulmonary disease, cerebrovascular disease, and left ventricular hypertrophy. A history of coronary artery disease including previous myocardial infarction or bypass operation did not predict late survival for this cohort. Conclusions. Given the substantial burden of comorbidity of veterans who use Department of Veterans Affairs facilities, the overall survival experience of this all male cohort compares well with previously published series and with overall U.S. male life expectancy. The fact that a history of coronary artery disease did not predict survival for this cohort may be related to selection bias; however, a more likely explanation is the presence of unsuspected coronary disease among patients without a documented history of angina or myocardial infarction.