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[Risk stratification in selective surgery of abdominal aortic aneurysm]

N A Iaitskiĭ, A Ia Bedrov, A A Moiseev

    Vestnik Khirurgii Imeni I. I. Grekova
    |July 25, 2014
    PubMed

    Insights

    Patients undergoing abdominal aortic aneurysm surgery often have cardiac issues. The V-POSSUM score better predicts postoperative complications and mortality than the Glasgow Aneurysm Score.

    Area of Science:

    • Cardiovascular Surgery
    • Vascular Surgery
    • Anesthesiology

    Context:

    • Abdominal aortic aneurysm (AAA) repair is associated with significant perioperative risk.
    • Patients undergoing AAA surgery frequently present with multiple comorbidities, particularly cardiac and pulmonary diseases.
    • Accurate risk stratification is crucial for optimizing patient selection and surgical planning.

    Purpose:

    • To analyze the prevalence of comorbidities in patients undergoing elective AAA repair.
    • To evaluate the incidence of early postoperative complications and mortality.
    • To compare the predictive performance of the Glasgow Aneurysm Score (GAS) and the V-POSSUM scoring system for risk stratification.

    Summary:

    • A retrospective analysis of 188 patients undergoing elective AAA surgery revealed universal cardiac pathology, with ischemic heart disease (93.0%) and arterial hypertension (94.1%) being most prevalent.
    • Postoperative complications occurred in 25% of patients, leading to a 10.6% mortality rate. Acute renal insufficiency was the most frequent complication (40% of fatal outcomes), followed by myocardial infarction and pneumonia.
    • Both GAS (up to 84) and V-POSSUM (up to 28) indicated high surgical risk, but ROC curve analysis demonstrated superior predictive ability for the V-POSSUM system.

    Impact:

    • Highlights the high-risk nature of elective AAA surgery due to prevalent comorbidities.
    • Identifies key postoperative complications and their contribution to mortality.
    • Suggests V-POSSUM as a more accurate tool for preoperative risk assessment in this patient population, potentially improving surgical decision-making and patient outcomes.

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