Systemic complications after elective abdominal aortic surgery. A retrospective analysis

While the range of systemic complications causing death after aortic surgery is well documented, the incidence is not. A study was undertaken to determine the incidence of systemic postoperative complications and the operative mortality of patients undergoing elective aortic surgery in a hospital that caters to a homogeneous population group. Records of 557 patients who had undergone aortic bypass or aneurysm replacement surgery over an 8-year period were studied at Addington Hospital, Durban. All had placement of a prosthetic fabric graft, 188 (33%) for aortic aneurysm replacement. Men made up 56% of the patients and the average age was 66 years. Standard selection criteria and peri-operative management were employed in all cases. All patients were classified according to the Goldman scoring system. There were significant systemic complications in 48 patients (8.6%), with 23 (4%) deaths. Respiratory complications were the most frequent (2.9%) followed by gastro-intestinal complications. (2.9%) followed by gastro-intestinal complications. The most frequent causes of death were cardiac arrest (20%) and gastro-intestinal malfunction, mainly bowel infarction. Only 3 patients developed acute renal failure in isolation but all died. When age was analysed as a factor in the causation of morbidity, there was an appreciably lower complication rate in patients under 50 years, but this reached a plateau in the 6th decade. The overall mortality and morbidity rates were acceptable. It would appear that age is weighted too heavily in the Goldman scoring system, although these criteria have reduced the incidence of cardiac complications.