Background
The risk of rupture of renal artery aneurysms (RAAs) remains undefined. A recent paper
from the Vascular Low-Frequency Disease Consortium (VLFDC) identified only 3 ruptures
in 760 patients. However, over 80% of patients in the VLFDC study were treated at
large academic centers, which may not reflect the pattern of care of RAAs nationwide.
Thus, the purpose of this study was to evaluate the pattern of nonelective versus
elective surgery requiring inpatient admission for RAAs, including nephrectomies,
and their outcomes using a national database.
Methods
The National Inpatient Sample (NIS) database from 2012 to 2018 was utilized. Patients
with a primary diagnosis of RAAs were identified using ICD-9 and ICD-10 codes. Ruptured
RAAs (rRAAs) were identified utilizing surrogate ICD codes. The primary outcome variables
for this study were proportion of RAAs requiring non-elective surgery and in-hospital
mortality.
Results
A total of 590 inpatient admissions for RAA were identified with 554 procedures at
467 hospitals across the country. Of the 590 inpatient admissions, 380 (64.4%) admissions
were deemed nonelective. There was an increasing proportion of nonelective admissions
over the study period. The overall rate of nephrectomies was 7.1% (n = 42). In-hospital mortality rate for the cohort was 1.4% (n = 8) with no differences in in-hospital mortality in the elective versus nonelective
setting (1.0% vs. 1.6%; P = 0.718). In the nonelective setting, patients requiring a nephrectomy (n = 23) had significantly higher rates of in-hospital mortality compared those not
requiring a nephrectomy (8.7% vs. 1.1%, P = 0.045). rRAA (n = 50) patients had significantly higher in-hospital mortality compared to the remainder
of the cohort (6.0% vs. 0.9%, P = 0.024). rRAA patients were also more likely to undergo a nephrectomy compared to
the remainder of the cohort (16.0% vs. 6.3%, P = 0.019).
Conclusions
These data demonstrate that treatment of RAAs are primarily done in the nonelective
setting with a high proportion of ruptures, which could continue to rise as the threshold
for repair has decreased.
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Article Info
Publication History
Published online: July 05, 2022
Accepted:
May 30,
2022
Received:
April 23,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Presented at the Southern Association of Vascular Surgery; Palm Beach, FL; 2022.
Identification
Copyright
Published by Elsevier Inc.
