Ruptured abdominal aortic aneurysms: risk factors for mortality after emergency repair

Emergency repair for ruptured aneurysm is associated with a high mortality rate. From our experience of treatment of ruptured abdominal aortic aneurysms (AAA), we evaluated the morbidity and mortality rates, and identified preoperative variables that may be predictive of mortality after emergency repair.

Retrospective review of 41 patients who had emergency ruptured AAAs repair during July 1996 to April 2002 in Middlemore Hospital, Auckland, New Zealand. Demographic, preoperative, intraoperative, and postoperative data were recorded and statistically analysed to identify predictors for mortality.

The mean age of the population was 72.9 years (range 57-89 years). Fifteen percent of patients died during the operation, and 26% died postoperatively. Bleeding was the most common cause of postoperative death (45%), followed by myocardial infarction (36%) and multisystem organ failure (27%). The overall surgical mortality rate was 41%. Serum creatinine of > or =0.15, age > or =80 years, 3 or more medical comorbidities and preoperative hypotension (systolic <90 mmHg) were identified to be significant risk factors for mortality (p<0.05) by univariate analysis. Serum creatinine of > or =0.15 mmol/L was the only variable multivariately (plt;0.05) associated with mortality with an odds ratio of 9.3.

Selection of patients with ruptured AAAs for emergency repair can be a complex and emotionally charged process. Simple preoperative variables with predictive values have been identified, which may be used to complement the surgeon's own patient selection criteria for emergency repair.