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The following is a summary of “Textbook Outcome’ in Endovascular Aortic Repair is Associated with Improved One-Year Survival,” published in the November 2024 issue of Surgery by Sickels et al.
A textbook outcome (TO) represents the ideal surgical result, yet its association with survival and factors affecting its achievement in endovascular aortic repair (EVAR), thoracic endovascular aortic repair (TEVAR), and complex endovascular aortic repair (cEVAR) has not been explored.
Researchers conducted a retrospective study to assess the impact of achieving a TO on 1-year mortality after elective EVAR, TEVAR, and cEVAR procedures.
They analyzed data from the Vascular Quality Initiative (VQI) registries for EVAR (2003-2023), TEVAR, and cEVAR (2011-2023) for elective aneurysm cases; TO was defined as freedom from major complications, reintervention, or mortality, prolonged stay, and discharge to the previous residence. Regression analysis identified factors linked to failure in achieving TO.
The results showed that TO was achieved in 77.6% (53,008), 69.3% (2,276), and 61.1% (3,306) of EVAR, TEVAR, and cEVAR cases, respectively. Kaplan-Meier estimates of 1-year survival were significantly higher in patients who achieved TO (EVAR: 96.3±0.1% vs. 87.0±0.6%; TEVAR: 94.2±1.2% vs. 78.3±2.7%; cEVAR: 94.8±1.0% vs. 82.0±2.0%; P<0.001). Achieving TO be the most protective factor against 1-year mortality (EVAR HR 0.36; 95% CI 0.33-0.39, TEVAR HR 0.27; 95% CI 0.27-0.35, cEVAR HR 0.24; 95% CI 0.20-0.30; all P<0.001). Factors linked to failure in achieving TO included age over 75, preoperative creatinine levels above 1.7 mg/dL, female sex, congestive heart failure (CHF), and dependent functional status (all P<0.05).
They concluded that failure to achieve a TO was associated with higher 1-year mortality, emphasizing the need for careful patient selection and perioperative optimization.
