Validating Three Scoring Systems for Predicting Mortality after a Ruptured Abdominal Aortic Aneurysm Repair in a...

Area of Science:

• Vascular Surgery
• Surgical Outcomes
• Predictive Analytics

Background:

• Existing scores for predicting 30-day mortality after ruptured abdominal aortic aneurysm (rAAA) intervention vary in performance.
• This study is the first to compare three key risk scores in an Australasian cohort, including diverse patient groups.

Purpose of the Study:

• To compare the discriminative ability of three risk prediction scores (Harborview Risk Score, Edinburgh Ruptured Aneurysm Score, Glasgow Aneurysm Score) for 30-day mortality in patients with rAAA.
• To evaluate the performance of these scores in operative and nonoperative management strategies.

Main Methods:

• A multicenter retrospective study included 256 patients with rAAA managed operatively or nonoperatively between 2010 and 2024 in New Zealand.
• Three risk scores (HRS, ERAS, GAS) were calculated for each patient.
• Receiver operating characteristic (ROC) curves were used to assess the discriminative ability of each score.

Main Results:

• The Harborview Risk Score (HRS) demonstrated superior predictive performance, with an Area Under the Curve (AUC) of 0.83 in the endovascular group and 0.69 in the open repair group.
• The Edinburgh Ruptured Aneurysm Score (ERAS) and Glasgow Aneurysm Score (GAS) showed lower AUC values (0.664 and 0.612, respectively).
• Each one-point increase in the HRS was associated with a 2.4-fold increase in 30-day mortality (OR 2.4, P <0.001).

Conclusions:

• The HRS is the most effective score for predicting 30-day mortality in patients undergoing both open and endovascular repair for rAAA.
• Integrating risk prediction scores with clinical judgment can enhance decision-making for rAAA patients.