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An R-Based Landscape Validation of a Competing Risk Model

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Multicenter Registry Validation of the Modified Harborview Risk Score for Risk Stratification in Ruptured Abdominal

Arjun Chaturvedi¹, Jeffrey Balian¹, Oh Jin Kwon¹

¹Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at University of California, Los Angeles, CA; Center for Advanced Surgical and Interventional Technology, Department of Surgery, University of California, Los Angeles, CA.

Annals of Vascular Surgery

|May 8, 2026

Summary

This summary is machine-generated.

The modified Harborview Risk Score (mHRS) predicts outcomes for ruptured abdominal aortic aneurysms (rAAA). Endovascular aneurysm repair (EVAR) shows better results than open surgical repair (OSR) across all mHRS risk levels.

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Area of Science:

Vascular Surgery
Surgical Outcomes Research
Risk Stratification

Background:

The modified Harborview Risk Score (mHRS) is a bedside tool for assessing operative risk in ruptured abdominal aortic aneurysms (rAAA).
Its performance across different surgical strategies in multicenter settings requires further evaluation.

Purpose of the Study:

To evaluate the performance of the mHRS in stratifying operative risk for patients with rAAA undergoing open surgical repair (OSR) versus endovascular aneurysm repair (EVAR).
To compare outcomes between OSR and EVAR across different mHRS risk strata.

Main Methods:

Retrospective analysis of the 2012-2022 American College of Surgeons National Surgical Quality Improvement Program Targeted EVAR dataset.
Included adult patients undergoing OSR or EVAR for rAAA.
Calculated mHRS and used multivariable regression and flexible parametric models to assess risk-adjusted outcomes.

Main Results:

Among 2,291 patients, 55.8% had EVAR and 44.2% had OSR.
Higher mHRS scores were associated with increased mortality and complications for both OSR and EVAR.
EVAR demonstrated improved risk-adjusted outcomes compared to OSR across all mHRS levels, particularly at higher scores (≥3).

Conclusions:

The mHRS effectively identifies increased morbidity and mortality risk in patients with rAAA undergoing both OSR and EVAR.
EVAR is associated with more favorable outcomes than OSR across all risk strata defined by the mHRS.