Key result
Complex AAA repair strongly predicts perioperative hypotension, which is linked to lower 30-day survival.
Why the study?
The study was conducted to identify risk factors for intraoperative and post-operative hypotension and evaluate their associations with mortality and serious adverse events following elective AAA repair.
Does intraoperative or post-operative hypotension increase the risk of mortality and serious adverse events in patients undergoing elective abdominal aortic aneurysm repair?
Cohort (n=511)
No
Does intraoperative or post-operative hypotension increase the risk of mortality and serious adverse events in patients undergoing elective abdominal aortic aneurysm repair?
Perioperative hypotension, particularly post-operative hypotension, is strongly associated with increased short- and long-term mortality following elective abdominal aortic aneurysm repair.
Objective To identify risk factors for intraoperative (IOH) and post-operative hypotension (POH) and evaluate their potential associations with mortality and serious adverse events after elective AAA repair. Methods A retrospective, single-center cohort study was conducted on patients who underwent elective open or endovascular abdominal aortic aneurysm repair between January 2013 and December 2021. Three definitions of IOH and POH were investigated: mean arterial pressure (MAP) < 60 mmHg, MAP < 65 mmHg, and systolic blood pressure (SBP) < 90 mmHg, all with durations of at least 5 minutes. Logistic regression was performed to identify predictors of IOH and POH, Cox regression analysis was used to assess the association between hypotension and mortality and serious adverse events, and Kaplan-Meier survival analysis was used to evaluate mortality. Results A total of 511 patients were included. The incidence of IOH and POH was higher in patients during complex versus non-complex procedures and POH occurred less frequently than IOH. Complex procedure was the main predictor of IOH and POH with HR's between 3.077 and 5.067 for IOH and 6.286-8.572 for POH. In addition, age, body mass index, and previous myocardial infarction were identified as predictors of IOH and female sex for POH MAP < 60 mmHg. IOH was associated with 30-day mortality according to both MAP definitions, but not with serious adverse events, procedure-related events or one-year mortality. POH was associated with 30-day and one-year mortality. Overall 30-day survival was 97.3% (SE 0.007, number at risk 497) and significantly lower in patients with IOH and POH. Overall one-year survival was 91.0% (SE 0.013, number at risk 465) and was significantly lower for those with POH, but not IOH, regardless of the definition used. Conclusion This study identifies that complexity of the procedure was the main predictor of both IOH and POH. Hypotension is associated with both 30-day and one-year mortality rates. Avoiding hypotension during and after surgery, or intervening at an earlier stage, might improve survival.
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Hu et al. (2026) conducted a cohort in Elective abdominal aortic aneurysm (AAA) (n=511). Complex procedure vs. Non-complex procedure was evaluated on Intraoperative (IOH) and post-operative hypotension (POH). Complex AAA repair procedures strongly predicted intraoperative (HR 3.077-5.067) and postoperative hypotension (HR 6.286-8.572), which were associated with significantly lower 30-day survival.
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