Association of Chronic Obstructive Pulmonary Disease and Mortality Following Thoracic and Complex Endovascular Aortic Repair

Abstract

Background

This study assessed the association between chronic obstructive pulmonary disease (COPD) severity and postoperative mortality among patients undergoing thoracic endovascular aortic repair (TEVAR) and complex endovascular aortic repair (CEVAR).

Methods

A retrospective review of the Vascular Quality Initiative database identified elective TEVAR and CEVAR cases from 2013 to 2022, with endograft proximal landing zone ≥2 for thoracic or complex abdominal aortic disease. Symptomatic diseases, ruptures, and urgent or emergent surgeries were excluded. Patients were stratified by COPD severity. The primary outcome was in-hospital mortality. Secondary outcomes included respiratory complications and 1-year mortality. Multivariable logistic regression was used for in-hospital mortality, respiratory complications, and 1-year mortality.

Results

Among 11,336 patients with TEVAR and CEVAR, 66% did not have COPD, 9% had COPD not on medications, 20% had COPD on medications, and 6% had COPD on home supplemental oxygen. In-hospital mortality was 2.3%, 3.7%, 3.2%, and 4.5% (P = 0.0004) respectively, and was not associated with increased odds of mortality. Respiratory complications occurred in 4.3%, 4.5%, 6.4%, and 7.3% (P < 0.0001) and were associated with increased odds for COPD on medications (OR 1.3) and COPD on home supplemental oxygen (OR 1.7). 1-year survival was 91%, 87%, 86%, and 80% and associated with increased risk for each COPD group (HR 1.4, HR 1.4, HR 1.9).

Conclusion

Patients with COPD undergoing TEVAR and CEVAR have increased rates of in-hospital mortality, respiratory complications, and 1-year mortality. COPD severity is independently associated with increased respiratory complications and 1-year mortality, which should be factored into preoperative decision-making.