Dementia Is Associated With Adverse Outcomes After Nonruptured Abdominal Aortic Aneurysm Repair
Samir K. Shah, Lingwei Xiang, Gilbert R Upchurch, Rachel R Adler, Khanjan B Shah, Clancy J. Clark, Emily Finlayson, Dae Hyun Kim, Kueiyu Joshua Lin, Stuart R Lipsitz, Joel S. WeissmanObjective:
To compare outcomes after nonruptured abdominal aortic aneurysm (AAA) repair among Medicare beneficiaries with and without Alzheimer disease and related dementias (ADRD).
Background:
AAA repair carries substantial risks; outcomes data in patients with ADRD are extremely limited.
Methods:
We conducted a retrospective cohort study using Medicare fee-for-service claims (2016–2020) of beneficiaries ≥66 years who underwent nonruptured AAA repair. ADRD was ascertained using a validated 12-month lookback algorithm. Outcomes were 30-, 90-day, and 1-year mortality, readmissions, major inpatient complications, and discharge destination. Associations were estimated with propensity score–weighted models adjusted for age, sex, race, Elixhauser comorbidity index, claims-based frailty, and repair type (endovascular vs open).
Results:
Of 42,733 repairs, 1817 (4.3%) involved patients with ADRD, who were older (median 80.8 vs 75.8 years), more often female (30.7% vs 25.0%), less often non-Hispanic White (84.2% vs 90.1%), and more likely to receive endovascular repair (89.1% vs 83.8%). Unadjusted outcomes were worse across mortality, readmissions, and major complications. After adjustment, ADRD was associated with higher mortality (30-day adjusted odds ratio [aOR] 1.50, 95% confidence interval [CI] 1.15–1.95; 1-year aOR 1.83, 95% CI 1.59–2.11), greater readmissions (30-day aOR 1.26, 95% CI 1.06–1.49; 90-day aOR 1.25, 95% CI 1.07–1.45), and increased discharge to higher-level care (aOR 2.46, 95% CI 2.12–2.85).
Conclusions:
In this national cohort, ADRD was associated with increased mortality, readmissions, and discharge to higher-level care after AAA repair despite more frequent use of endovascular repair.