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Analysis of Postoperative Morbidity

Larry H. Hollier, MD; Jeffrey B. Symmonds, MD; Peter C. Pairolero, MD; Kenneth J. Cherry, MD; John W. Hallett, MD; Peter Gloviczki, MD

Arch Surg. 1988;123(7):871-875.

Abstract
• Between 1980 and 1986, 101 nondissecting thoracoabdominal aortic aneurysms (TAAAs) were repaired at the Mayo Clinic, Rochester, Minn. Overall mortality was 15% with a 9.6% mortality for elective repair. Nonfatal complications occurred in 44% of patients and included myocardial infarction in 9%, paraplegia in 5%, and renal failure in 4%. In an attempt to reduce morbidity and mortality associated with TAAA repair, one of our vascular surgical services set up a routine protocol of preoperative evaluation, standardized operative technique, and specific guidelines for perioperative management. Fifty-five of the 101 patients underwent elective repair on this service without the use of shunts or bypass. Mortality was reduced to 1.8% and the rate of myocardial infarction was reduced to 1.8%; none of these patients developed renal failure. However, paraplegia/paraparesis still occurred in 5.4% and pulmonary insufficiency occurred in 29%. Preoperative cardiac evaluation and intraoperative reduction of cardiac afterload are important factors in reducing myocardial infarction and death associated with TAAA repair and should be integrated into the management of these patients. However, preexisting pulmonary and renal disease in some patients may limit the surgeon's ability to reduce rates of some complications.

(Arch Surg 1988;123:871-875)

Author Affiliations
From the Department of Surgery, Ochsner Clinic, New Orleans (Dr Hollier), and the Section of Vascular Surgery, Mayo Clinic, Rochester, Minn (Drs Symmonds, Pairolero, Cherry, Hallett, and Gloviczki).

Footnotes
Accepted for publication Feb 18, 1988.

Read before the 95th Annual Meeting of the Western Surgical Association, Dallas, Nov 18, 1987.

Reprint requests to Chairman, Department of Surgery, Ochsner Clinic, 1514 Jefferson Hwy, New Orleans, LA 70121 (Dr Hollier).

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