Ruptured Abdominal Aortic Aneurysms

OBJECTIVE: To determine the relative contribution of preoperative, operative, and postoperative factors to mortality in patients with ruptured abdominal aortic aneurysms. DESIGN: Retrospective case series. SETTING: Three primary care hospitals in a community setting. PATIENTS: Ninety-nine patients operated on for ruptured abdominal aortic aneurysms in the selected community between January 1984 and January 1992. OUTCOME MEASURES: Preoperative, operative, and postoperative factors were subjected to univariate and multivariate analysis to determine their relative contribution to patient mortality. Differences were considered significant at P = .05. RESULTS: The overall in-hospital mortality rate was 57%. The independent predictors of death were patient's age, surgical expertise, major intraoperative technical problems, hematocrit on admission, and units of red blood cells transfused during surgery (P < .05 for each). The operative mortality rate for individual surgeons ranged from 20% to 100%. Fifteen technical errors were identified, resulting in a 43% mortality rate. Surgeons with the highest mortality rates had the highest incidence of iatrogenic technical problems (P > .001). CONCLUSIONS: The outcome of patients with ruptured abdominal aortic aneurysms is, in part, determined by their preoperative status; however, surgical expertise and the avoidance of technical error significantly impact survival in patients with ruptured abdominal aortic aneurysms and should be a major focus of our attention.