Patients with Ruptured Abdominal Aortic Aneurysm Have Become Higher Risk

Area of Science:

• Vascular Surgery
• Geriatric Medicine
• Epidemiology

Background:

• Established risk factors for ruptured abdominal aortic aneurysm (rAAA) mortality include age, loss of consciousness, elevated creatinine, low hemoglobin, and ECG ischemia.
• An aging Australian population prompted an investigation into current rAAA patient risk factors and their predictive value.

Purpose of the Study:

• To determine if patients presenting with rAAA in the modern era have more predictive risk factors for mortality compared to a past era.
• To assess if these previously identified risk factors remain predictive of mortality in contemporary rAAA patients.

Main Methods:

• Retrospective analysis of rAAA patient records from two distinct eras: 1985-1993 (past) and 2007-2011 (modern).
• Construction of a database including independent risk factors, repair methods, and mortality outcomes.
• Statistical comparison of patient demographics, risk factors, and mortality rates between the two eras using P < 0.05 as the significance threshold.

Main Results:

• The modern era group had a higher median age (81 vs. 72 years) and more risk factors per patient (2 vs. 1) compared to the past era.
• A higher proportion of patients were rejected for surgery in the modern era (22/60 vs. 34/188).
• In-hospital mortality for patients undergoing rAAA repair remained constant at 39% across both eras, with low hemoglobin identified as the sole independent predictor of mortality in the modern group.

Conclusions:

• Modern era patients with rAAA are older and present with a greater number of mortality risk factors.
• Increased surgical rejection rates were observed in the modern era, influenced by comorbidities and patient/family/surgeon preferences.
• Despite increased pre-operative risk, mortality following rAAA repair has not changed, indicating a need to revise existing predictive risk factor models.