Dementia Is Associated With Adverse Outcomes After Nonruptured Abdominal Aortic Aneurysm Repair.

OBJECTIVE: To compare outcomes after nonruptured abdominal aortic aneurysm (AAA) repair among Medicare beneficiaries with and without Alzheimer disease and related dementias (ADRD). BACKGROUND: AAA repair carries substantial risks; outcomes data in patients with ADRD are extremely limited. METHODS: We conducted a retrospective cohort study using Medicare fee-for-service claims (2016-2020) of beneficiaries ≥66 years who underwent nonruptured AAA repair. ADRD was ascertained using a validated 12-month lookback algorithm. Outcomes were 30-, 90-day, and 1-year mortality, readmissions, major inpatient complications, and discharge destination. Associations were estimated with propensity score-weighted models adjusted for age, sex, race, Elixhauser comorbidity index, claims-based frailty, and repair type (endovascular vs open). RESULTS: Of 42,733 repairs, 1817 (4.3%) involved patients with ADRD, who were older (median 80.8 vs 75.8 years), more often female (30.7% vs 25.0%), less often non-Hispanic White (84.2% vs 90.1%), and more likely to receive endovascular repair (89.1% vs 83.8%). Unadjusted outcomes were worse across mortality, readmissions, and major complications. After adjustment, ADRD was associated with higher mortality (30-day adjusted odds ratio [aOR] 1.50, 95% confidence interval [CI] 1.15-1.95; 1-year aOR 1.83, 95% CI 1.59-2.11), greater readmissions (30-day aOR 1.26, 95% CI 1.06-1.49; 90-day aOR 1.25, 95% CI 1.07-1.45), and increased discharge to higher-level care (aOR 2.46, 95% CI 2.12-2.85). CONCLUSIONS: In this national cohort, ADRD was associated with increased mortality, readmissions, and discharge to higher-level care after AAA repair despite more frequent use of endovascular repair.