Survival improvement following aortic aneurysm resection

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Surgical Outcomes Research

Background:

• Abdominal aortic aneurysm (AAA) resections have evolved significantly over time.
• Historical data from 1955-1965 provides a baseline for comparison.
• Advances in surgical practice necessitate updated outcome analysis.

Purpose of the Study:

• To evaluate the changes in hospital mortality and long-term survival rates for AAA resections.
• To compare outcomes between different time periods (1955-1965 vs. 1966-1973).
• To identify factors contributing to improved surgical results.

Main Methods:

• Retrospective analysis of 298 AAA resections performed between 1966-1973.
• Comparison with 186 previously reported resections from 1955-1965.
• Calculation of actuarial survival rates at 5 years for different aneurysm types (elective, urgent intact, emergency ruptured).

Main Results:

• Hospital mortality for elective AAA resections decreased from 13% (1955-1965) to 4.2% (last 3 years of 1966-1973).
• Mortality for urgent resections of intact aneurysms dropped from 36% to 6% (1966-1973).
• Emergency resection mortality for ruptured aneurysms reduced from 69% to 42% (last 3 years).
• Five-year actuarial survival was 65% (urgent intact), 60% (elective), and 40% (emergency ruptured).
• Atherosclerosis complications (myocardial infarction, stroke) were the primary cause of late mortality.

Conclusions:

• Significant improvements in AAA resection outcomes are attributed to enhanced surgical techniques, postoperative care, and increased surgeon experience.
• A trend towards more elective resections of smaller, asymptomatic aneurysms contributed to better results.
• Elective resection is recommended for all suitable patients due to current low mortality rates.