In an observational study of over 42,000 non-ruptured abdominal aortic aneurysm (AAA) repairs, researchers identified that dementia confers “clinically meaningful higher risks” across a spectrum of outcomes from mortality to discharge to higher levels of care.
Samir K Shah (University of Florida, Gainesville, USA) presented this and other key findings from the “first-ever” US national cohort study focused solely on AAA outcomes in patients with dementia at the 50th annual meeting of the Southern Association for Vascular Surgery (SAVS 2026; 21–24 January, Paradise Island, the Bahamas).
Shah detailed that, while AAA carries significant risks of mortality and morbidity, contemporary knowledge of real-world outcomes in patients with Alzheimer’s disease and related dementias (ADRD) is “sparse”. It was the aim of the present study to characterise the outcomes of AAA repair in patients with ADRD.
The researchers queried Medicare fee-for-service claims from 2016–2020 to identify beneficiaries aged 66 years and older who underwent elective, non-ruptured, open or endovascular AAA repair.
At SAVS 2026, Shah detailed that the cohort study included 42,733 unique repairs, including 1,817 (4.3%) in patients with ADRD. The presenter noted that, compared with the non-ADRD cohort, the ADRD group was older, more likely to be female, and less likely to be non-Hispanic white. He added that patients with ADRD were more likely to receive endovascular repair.
Shah reported that unadjusted outcomes were “significantly worse” for patients with ADRD, highlighting p-values of less than 0.001 across the board. Specifically, the presenter shared that 30-day mortality was 6.9% in the ADRD group compared to 3.6% in the non-ADRD group, with corresponding figures of 12.7% vs 5.9% for 90-day mortality. The same observation was made for major inpatient complications, 30-day readmission, discharge to higher-level care, and 90-day time-at-home ratio.
After adjusting for age, sex, race, Elixhauser comorbidity index, frailty, and repair type using propensity-score-weighted models, the researchers found that ADRD remained independently associated with worse mortality and readmissions at 30 and 90 days, major inpatient complications, and discharge to higher-level care.
“These data should be used as a foundation for shared decision-making with patients and surrogate decision-makers,” Shah concluded, noting that future work should focus on the use of routine cognitive screening, goal-concordant counselling, and perioperative optimisation to improve outcomes and ensure that treatment aligns with patient goals.
