Of the 35 701 elective AAA repairs identified in the VASQIP database, we included 35 163 performed at 97 hospitals. 5 Statistical analyses were performed with Stata 15.1 and GraphPad Prism 7.0 software. Adjusted mortality equivalence was determined by a ☐.5% margin. Postestimation adjusted mortality rates were calculated from mixed-effects logistic regression including continuous variables (age, RAI) as fixed effects and categorical variables (year, hospital) as random effects, chosen a priori. 4 Our primary outcome was the 30-day mortality rate (reported with 95% CIs) stratified by frailty and age.
![graphpad prism 6 user guide graphpad prism 6 user guide](https://docplayer.net/docs-images/42/22954611/images/page_20.jpg)
The RAI is a validated frailty measure, with scores indicating robust (≤20), normal (21-29), or frail (≥30) physiologic reserve.
![graphpad prism 6 user guide graphpad prism 6 user guide](https://www.graphpad.com/guides/prism/latest/user-guide/images/hmfile_hash_5ffbe0c9.png)
We included all elective AAA repairs in the VASQIP database and excluded those missing a Risk Analysis Index (RAI) score.
![graphpad prism 6 user guide graphpad prism 6 user guide](https://img.informer.com/screenshots/38/38716_4.gif)
The study followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE) reporting guideline. The study was thus deemed exempt from Veterans Affairs Pittsburgh Healthcare System Institutional Review Board approval and informed consent was waived. This cohort study evaluated 2011 to 2019 data from the VASQIP database in such a manner that participants could not be identified. 4 Using data from the US Veterans Affairs Surgical Quality Improvement Program (VASQIP), we hypothesize that veterans with a robust physiologic reserve have equivalently low risks (≤1%) of early postoperative mortality after undergoing OSR or EVAR. 3 However, early postoperative mortality is determined by both the physiologic stress of the intervention and the patient’s physiologic reserve (ie, robust or frail). Traditionally, surgical procedures have been arbitrarily defined as high risk by a postoperative mortality rate of greater than 1%. 1 This early EVAR advantage, however, must be weighed against the need for more frequent follow-up and increased aortic interventions. When the AAA anatomy meets instructions for use for an aortic endograft, endovascular aneurysm repair (EVAR) is preferred because of its lower rates of early postoperative complications and mortality compared with open surgical repair (OSR). The elective repair of abdominal aortic aneurysms (AAAs) mitigates their risk of AAA rupture.
![graphpad prism 6 user guide graphpad prism 6 user guide](https://docplayer.net/docs-images/42/22954611/images/page_12.jpg)
Dashed horizontal lines indicate 1% postoperative 30-day mortality, and rates above this range indicate the historical definition of a high-risk procedure. The observed (bars) and risk-adjusted (points) rates of 30-day mortality are shown for EVAR and OSR for all AAA repairs and stratified by frailty category (robust ).