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Related Experiment Videos

Predicting death from ruptured abdominal aortic aneurysms.

Y N Hsiang1, R G Turnbull, S C Nicholls

  • 1Department of Surgery, Division of Vascular Surgery, Vancouver Hospital, University of British Columbia, 700 West 12th Avenue, Vancouver, BC, Canada. hsiang@interchange.ubc.ca

American Journal of Surgery
|March 15, 2001
PubMed
Summary
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A new study found that a preoperative formula for ruptured abdominal aortic aneurysm (rAAA) mortality risk may be useful for high-risk patients. However, the immediate postoperative formula for rAAA was not effective in predicting death.

Area of Science:

  • Vascular Surgery
  • Surgical Outcomes Research
  • Medical Informatics

Background:

  • Previously developed formulae estimated mortality for ruptured abdominal aortic aneurysms (rAAA) preoperatively and postoperatively.
  • This study prospectively validated these predictive models against actual patient outcomes.

Purpose of the Study:

  • To prospectively compare the accuracy of previously reported preoperative and immediate postoperative mortality risk formulae in patients with ruptured abdominal aortic aneurysms (rAAA).

Main Methods:

  • Prospective data collection from 134 patients across two centers over three years.
  • Preoperative risk assessment utilized coefficients for age, consciousness level, and cardiac arrest.
  • Postoperative risk assessment incorporated coagulopathy, ischemic colitis, inotrope requirements, time to surgery, age, myocardial infarction, renal failure, and hemoglobin levels.

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Main Results:

  • The study included 134 patients (15% female, average age 73 years); 47% survived.
  • For preoperative risk >90%, sensitivity was 25%, specificity 98%, PPV 95%, NPV 54%.
  • For immediate postoperative risk >=90%, sensitivity was 17%, specificity 87%, PPV 60%, NPV 49%.

Conclusions:

  • The preoperative mortality risk formula shows potential utility for ruptured abdominal aortic aneurysm (rAAA) patients with predicted mortality >/=90%, due to its high positive predictive value.
  • The immediate postoperative mortality risk formula for rAAA was found to be not useful for predicting patient death.