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Experience in managing 70 patients with ruptured abdominal aortic aneurysms
J R Cohen1, E Birnbaum, M Kassan
1Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, NY 11042.
New York State Journal of Medicine
|March 1, 1991
Summary
Ruptured abdominal aortic aneurysm repair outcomes improved with fewer surgeons and better blood pressure management. Patients with systolic blood pressure over 100 mm Hg had better survival, regardless of surgical delay up to six hours.
Area of Science:
- Vascular Surgery
- Surgical Outcomes Research
Background:
- Ruptured abdominal aortic aneurysms (RAAAs) present a critical surgical emergency with high mortality.
- Factors influencing RAAA repair survival require ongoing investigation.
Purpose of the Study:
- To analyze factors affecting mortality in ruptured abdominal aortic aneurysm (RAAA) repair.
- To identify predictors of survival and assess the impact of surgical experience.
Main Methods:
- Retrospective analysis of 70 ruptured abdominal aortic aneurysm (RAAA) cases from 1975-1989.
- Correlation of mortality with patient demographics, comorbidities, preoperative and intraoperative parameters, and surgeon experience.
Main Results:
- Mortality correlated with admitting systolic blood pressure, blood pressure at skin incision, operative time, and blood loss.
- Patients with systolic blood pressure > 100 mm Hg had better survival.
- Mortality decreased significantly from 76% (11 surgeons) before 1985 to 54% (6 surgeons) after 1985.
Conclusions:
- Profound hypotension on admission or at incision predicts poor survival in RAAA repair.
- Systolic blood pressure > 100 mm Hg is a key determinant of survival.
- Centralizing RAAA repairs among a smaller group of experienced vascular surgeons improves outcomes.