Key result
Preoperative risk score predicts up to ~100% 30-day mortality after open RAAA repair.
Why the study?
Existing predictive models lack solid evidence for predicting survival with absolute precision after open ruptured abdominal aortic aneurysm repair.
Can a preoperative risk score accurately predict 30-day mortality in patients undergoing open ruptured abdominal aortic aneurysm repair?
Cohort (n=500)
No
Can a preoperative risk score accurately predict 30-day mortality in patients undergoing open ruptured abdominal aortic aneurysm repair?
A simple 5-point preoperative risk score based on bedside clinical variables can accurately predict 30-day mortality after open repair of ruptured abdominal aortic aneurysms.
Preoperative factors may aid mortality prediction after open RAAA repair; leaves open external validation before clinical use.
Background and Objectives: Despite the relatively large number of publications concerning the validation of these models, there is currently no solid evidence that they can be used with absolute precision to predict survival. The goal of this study is to identify preoperative factors that influenced 30-day mortality and to create a predictive model after open ruptured abdominal aortic aneurysm (RAAA) repair. Materials and Methods: This was a retrospective single-center cohort study derived from a prospective collected database, between 1 January 2009 and 2016. Multivariate logistic regression analysis was used to identify all significant predictive factors. Variables that were identified in the multivariate analysis were dichotomized at standard levels, and logistic regression was used for the analysis. To ensure that dichotomized variables were not overly simplistic, the C statistic was evaluated for both dichotomized and continuous models. Results: There were 500 patients with complete medical data included in the analysis during the study period. Of them, 37.6% were older than 74 years, and 83.8% were males. Multivariable logistic regression showed five variables that were predictive of mortality: age > 74 years (OR = 4.01, 95%CI 2.43−6.26), loss of consciousness (OR = 2.21, 95%CI 1.11−4.40), previous myocardial infarction (OR = 2.35, 95%CI 1.19−4.63), development of ventricular arrhythmia (OR = 4.54, 95%CI 1.75−11.78), and DAP < 60 mmHg (OR = 2.32, 95%CI 1.17−4.62). Assigning 1 point for each variable, patients were stratified according to the preoperative RAAA mortality risk score (range 0−5). Patients with 1 point suffered 15.3% mortality and 3 points 68.2% mortality, while all patients with 5 points died. Conclusions: This preoperative RAAA score identified risk factors readily assessed at the bedside and provides an accurate prediction of 30-day mortality after open repair of RAAA.
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Tomić et al. (2022) conducted a cohort in ruptured abdominal aortic aneurysm (RAAA) (n=500). Preoperative RAAA mortality risk score vs. Lower score was evaluated on 30-day mortality. A 5-point preoperative risk score accurately predicted 30-day mortality after open RAAA repair, with mortality rates of 15.3% for 1 point, 68.2% for 3 points, and 100% for 5 points.
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