An “all comers” policy for ruptured abdominal aortic aneurysms: how can results be improved?

OBJECTIVE: To review our experience of a non-selective policy for the treatment of ruptured abdominal aortic aneurysm to see if the policy was justified, and to identify any preoperative risk factors that adversely influenced outcome. DESIGN: Retrospective study. SETTING: Teaching hospital, Republic of Ireland. SUBJECTS: 258 patients admitted with abdominal aortic aneurysms between January 1982 and December 1993. INTERVENTIONS: Definitive surgical treatment. MAIN OUTCOME MEASURES: Morbidity, mortality, and risk factors. RESULTS: In-hospital mortality for all patients was 43% (110/258). Overall, women did worse than men (28/44, 64%, died, compared with 96/214, 45%, p=0.03). The mortality among patients over the age of 80 (23/45, 51%) was not significantly different from that among younger patients (97/202, 48%). Blood pressure, platelet count, and haemoglobin concentration were all significantly lower preoperatively among those who died (p < 0.05). CONCLUSIONS: Age alone cannot be used to justify witholding definitive surgical treatment. Treatment should be aimed towards reversing haematological and haemodynamic abnormalities preoperatively to try to improve outcome.