Ruptured Abdominal Aortic Aneurysms

Publisher Website
Google Scholar
Abstract
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. (Arch Surg. 1994;129:285-290)