Ruptured aortic aneurysm: Early postoperative prediction of mortality using an organ system failure score

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Abstract
Ruptured abdominal aortic aneurysm (AAA) is a personal and public health catastrophe because of the high and unimproving mortality rate, increasingly long intensive care unit (ICU) stay and rising hospital costs. Criteria are needed to identify patients with a poor prognosis so that treatment and resources may be directed to those with a better outlook. This retrospective study reviews perioperative variables, outcome and length of ICU stay for 99 consecutive patients with operated ruptured infrarenal AAA between 1985 and 1992 who reached the ICU alive. Early death (within 48 h) occurred in 20 per cent using 24 ICU days and late death (after 48 h) occurred in 29 per cent using 420 ICU days; neither type of death could be predicted before operation. Multiple organ failure, the cause of 93 per cent of late deaths, was assessed for each patient 48 h after operation using an organ system failure score. There was a strong positive correlation between organ system failure score and mortality rate (P<0.00001); all 20 patients with more than two failing organ systems died. If used in decision making the score would have saved 43 per cent of the ICU days associated with late mortality. Withdrawing postoperative treatment at an early stage in accordance with an organ system failure score may be a defensible and cost-effective option.