Ruptured abdominal aortic aneurysm. Is it possible to predict outcome?

Area of Science:

• Vascular Surgery
• Surgical Outcomes Research
• Aortic Aneurysm Management

Background:

• High mortality rates persist following ruptured abdominal aortic aneurysm (rAAA) repair.
• The Hardman Index, comprising age, loss of consciousness, ECG ischemia, creatinine, and hemoglobin, was proposed to predict perioperative death.
• A score of 3 or more on the Hardman Index indicated 100% mortality.

Purpose of the Study:

• To validate the predictive accuracy of the Hardman Index for mortality in patients with rAAA.
• To investigate potential modifications to the Hardman Index for improved prediction.
• To assess the significance of individual Hardman Index criteria and systolic blood pressure in predicting rAAA outcomes.

Main Methods:

• Retrospective analysis of 137 patients who underwent surgery for rAAA.
• Evaluation of the 5 factors of the Hardman Index.
• Inclusion of preoperative and post-resuscitation systolic blood pressure as additional predictive variables.

Main Results:

• Overall mortality for rAAA was 56.2%.
• Age, ECG ischemia, creatinine, and hemoglobin were significant predictors (p<0.05). Loss of consciousness was not significant (p=0.9054).
• A modified index replacing loss of consciousness with systolic blood pressure <100 mmHg demonstrated improved mortality prediction across all risk scores.

Conclusions:

• The Hardman Index is effective in predicting outcomes after rAAA, but loss of consciousness is not a significant predictor.
• Systolic blood pressure is a valuable addition to predictive indices for rAAA.
• Further research into predictive indices is warranted, with a focus on preventive screening for rAAA.