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The Modified Harborview Risk Score Successfully Predicts Mortality after Ruptured Abdominal Aortic Aneurysm Repair.

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The modified Harborview Risk Score (mHRS), using international normalized ratio (INR), accurately predicts 30-day mortality in ruptured abdominal aortic aneurysm (rAAA) repair. This score offers improved clinical utility over traditional methods.

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Area of Science:

  • Vascular Surgery
  • Surgical Outcomes Research
  • Risk Stratification

Background:

  • Traditional Harborview Risk Score uses 4 criteria for ruptured abdominal aortic aneurysm (rAAA) mortality prediction.
  • Preoperative arterial pH measurement is often difficult, limiting the clinical utility of the traditional score.
  • International normalized ratio (INR) > 1.8 is proposed as a substitute for arterial pH in predicting rAAA mortality.

Purpose of the Study:

  • To validate the modified Harborview Risk Score (mHRS) for predicting 30-day mortality after surgical repair of rAAA.
  • To assess the clinical utility of the mHRS compared to the traditional Harborview Risk Score and the Vascular Study Group of New England (VSGNE) score.

Main Methods:

  • Retrospective analysis of 69 patients with rAAA from 2011-2022 at a single tertiary-care center.
  • Comparison of mHRS and VSGNE scores using logistic regression and receiver operating characteristic (ROC) curves.
  • Evaluation of 30-day mortality as the primary outcome.

Main Results:

  • The 30-day mortality rate was 38% overall, with higher rates for open repairs (58%) vs. endovascular repairs (30%).
  • The mHRS demonstrated a stronger linear relationship with 30-day mortality (R²=0.97) compared to the VSGNE score (R²=0.94).
  • No significant difference was found in ROC curve areas between mHRS and VSGNE scores, though both showed predictive capability.

Conclusions:

  • The mHRS accurately predicts 30-day mortality after rAAA repair using the INR > 1.8 criterion.
  • The mHRS offers broader clinical utility due to its reliance on easily obtainable preoperative variables.
  • The mHRS is a superior scoring system compared to the traditional Harborview Risk Score and VSGNE scores for rAAA repair outcomes.