Association between Operating Time and Post-operative Outcomes in Complex Aortic Endografting: A Single Centre Retrospective Observational Study.

Abstract

The aim of this study was to evaluate the association between operating time (OT) and post-operative outcomes in complex endovascular aortic repair and to explore contributing factors to OT. This retrospective, observational cohort study analysing data from a single centre included patients undergoing fenestrated endovascular aortic repair (FEVAR), branched endovascular aortic repair (BEVAR), or arch branched endovascular aortic repair (aBEVAR) from February 2018 to December 2024. OT was defined as the interval from first arterial access to closure. Factors influencing OT, including hospital volume, learning curve (LC), adjunctive procedures, and differences in operating technique adopted, were analysed. The effects of prolonged OT on 30 day complication and mortality rates were also assessed. Five hundred and thirty patients underwent complex endovascular aortic repair, including 322 FEVAR, 108 BEVAR, and 100 aBEVAR. The median age was 78 years (interquartile range 72, 84), with no statistically significant differences between groups. OT varied by procedure, with a median of 145 minutes for FEVAR, 181 minutes for BEVAR, and 159.5 minutes for aBEVAR. When stratified by OT tertiles, the 30 day mortality rate was statistically significantly higher in the longest tertile (9.1%) compared with the shortest (0.0%) (p < .001), while technical success exceeded 95% in all groups. A multivariable analysis confirmed that prolonged OT remained independently associated with increased 30 day death (per minute increase, adjusted odds ratio 1.010, 95% confidence interval 1.003 - 1.017; p = .003). Although major and minor complications were more frequent in the highest tertile, these differences did not reach statistical significance. OT decreased consistently over the study period across all procedure types (p < .001), despite increasing procedural complexity. Sensitivity analyses supported a strong LC effect, with significant reductions in OT. In this high volume, single centre experience, prolonged OT was independently associated with an increased 30 day mortality rate after complex aortic endovascular repair. While outcomes improved over time alongside reductions in OT, these findings should be interpreted with caution given the retrospective design.