Key result
Presence of 3 vs 0-1 risk factors (hemoglobin <9 g/dl, BP <90 mmHg, GCS <15) increased 30-day/in-hospital mortality after ruptured AAA repair from 29% to 80% (P=0.003 for cumulative association).
Observational (n=105)
p-value: p=0.003
Hemoglobin <9 g/dl, blood pressure <90 mmHg, and Glasgow Coma Scale <15 are easily assessed preoperative risk factors that strongly predict mortality after ruptured AAA repair.
These factors were associated with high mortality after ruptured AAA repair; hypothesis-generating and should not yet change practice.
BACKGROUND: Many surgeons adopt a selective policy of intervention for a ruptured abdominal aortic aneurysm (AAA). This study aimed to develop an objective method of identifying patients suitable for attempted repair. METHODS: Consecutive patients selected for attempted repair of ruptured AAA over a 31-month period (January 2000 to July 2002) were entered into an observational study. Altogether, 53 preoperative physiological and biochemical variables were recorded and related to operative outcome. RESULTS: A total of 105 patients underwent attempted repair of a ruptured AAA. There were 39 (37%) deaths in hospital or within 30 days of operation. On univariate analysis, hemoglobin <9 g/dl (p = 0.038), blood pressure <90 mmHg (p = 0.036), and Glasgow Coma Scale <15 (p = 0.016) were found to be risk factors that predicted death. Of 70 patients with no or one risk factor, 20 (29%) died. Of 30 patients with two factors, 15 (50%) died, and of the five patients with all three factors, four (80%) died. There was a significant association between mortality and cumulative risk factors (p = 0.003). CONCLUSION: These three risk factors are easily assessed in the emergency setting and might form the basis of a scoring system to inform the outcome of ruptured AAA.
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Tambyraja et al. (2007) conducted an observational in Ruptured abdominal aortic aneurysm (n=105). Cumulative risk factors (hemoglobin <9 g/dl, blood pressure <90 mmHg, Glasgow Coma Scale <15) vs. Fewer or no risk factors was evaluated on Death in hospital or within 30 days of operation (p=0.003). Presence of 3 vs 0-1 risk factors (hemoglobin <9 g/dl, BP <90 mmHg, GCS <15) increased 30-day/in-hospital mortality after ruptured AAA repair from 29% to 80% (P=0.003 for cumulative association).
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