Predictors and Outcomes of Surgical Delay in Open Abdominal Aortic Aneurysm Repair.

Introduction: The objectives of this study are to characterize surgical waiting times experienced by patients undergoing elective open abdominal aortic aneurysm (AAA) repair, as well as to identify predictors and adverse outcomes associated with surgical delay.

Methods: A retrospective chart review of patients undergoing open AAA repair between 2015-2025 was carried out in two hospital centres. Patients were excluded from the study if they were not planned to undergo an elective operation. Demographic, preoperative, and postoperative data were collected, including the time course between the preoperative abdominal computed tomography (CT) scan, procedure consent, preoperative clinic evaluation and surgery date. Surgical delay was defined as a wait time of >8 weeks and assessed from both the preoperative CT scan and consent date to the day of surgery. Linear and logistic regression analyses were used to identify predictors and adverse postoperative outcomes of surgical delay.

Results: Out of 468 charts reviewed, 298 patients were included in the study. The median time from the preoperative CT scan to surgery was 92 days [IQR 59-142, n=247], while the median time from the date of consent to surgery was 61 days [IQR 40-103, n=296]. Patients waited a median of 21 days [IQR 10-33, n=289] after seeing the vascular surgeon to be assessed by preoperative medicine. Multivariable logistic regression showed that predictors of surgical delay from the time of consent to surgery were cerebrovascular disease (OR 5.209, 95% CI 1.77, 19.26, p=0.006), juxtarenal aneurysms (OR 2.402, 95% CI 1.36, 4.35, p=0.003) and smaller AAA diameter (OR 0.915, 95% CI 0.88, 0.95, p=7.1e-6). Only smaller aneurysm diameter was a significant predictor of delay (OR 0.915, 95% CI 0.88, 0.95, p=9.22e-6) from the time of the CT scan to surgery. Prolonged time to surgery was associated with a small but significant increase in the comprehensive complication index in both univariable (β=0.426, 95% CI 0.17, 0.69, p=0.001) and multivariable linear regression (β=0.341, 95% CI 0.10, 0.58, p=0.006). The incidence of interval ruptures (n=1, 0.7%) and symptomatic AAAs (n=5, 1.7%) in the waiting period were low.

Conclusions: In this review, patients with prolonged surgical delay well beyond 8 weeks are at risk of experiencing a higher postoperative complication burden and should be identified pre-emptively to ensure timely intervention.