Predictors for the immediate and long-term outcome of a vascular surgical procedure

The ability to predict post-operative mortality reliably will be of assistance in making decisions concerning the treatment of an individual patient. The aim of this study was to test the GAS score as a predictor of post-operative mortality in vascular surgical patients.

A total of 157 consecutive patients who underwent an elective vascular surgical procedure were included in the study. The Cox proportional hazards model was used in analyzing the importance of various preoperative risk factors for the postoperative outcome. ASA and GAS were tested in predicting the short and longterm outcome. On the basis of the GAS cut-off value 77, patients were selected into low-risk (GAS low: GAS<77) and high-risk (GAS high: GAS>or=77) groups, and the examined risk factors were analyzed to determine which of them had predictive value for the prognosis.

None of the patients in the GAS low group died, and mortality in the GAS high group was 4.8% (p=0.03) at 30 days follow-up. The 12-month survival rates were 98.6% and 78.6% (p=0.0001), respectively, with the respective 5-year survival rates of 76.7% and 44.0% (p=0.0001). The only independent risk factor for 30-day mortality was the renal risk factor (OR 20.2). The combination of all three GAS variables (chronic renal failure, cardiac disease and cerebrovascular disease), excluding age, was associated with a 100% two-year mortality.

Mortality is low for patients with GAS<77. For the high-risk patients (GAS>or=77), due to its low predictive value for death, GAS yields limited value in clinical practice. In cases of patients with all three risk factors (renal, cardiac and cerebrovascular), vascular surgery should be considered very carefully.