Thoraco-abdominal aneurysm resection. Determinants of survival in a community hospital

Twenty-five patients who underwent resection of a thoraco-abdominal aneurysm between 1985-1993 were reviewed to study determinants of survival in patients undergoing the procedure in a community hospital. Twelve procedures were performed electively, six urgently and seven emergently. Type I aneurysm was present in one patient (n = 1), Type II n = 7; Type III n = 5 and Type IV = 12. Hypertension (n = 17), cardiac disease (n = 10) and renal insufficiency (n = 4) were most common risk factors. Aneurysms were repaired using inclusion method without special techniques for renal or spinal cord preservation. Eighteen patients survived and were discharged; four patients died 30 days and three patients died 30 days. Causes of death were multisystem failure (n = 3), acute myocardial infarction (n = 2) coagulopathy (n = 1) and bowel infarction (n = 1). Major complications included renal failure (n = 2) myocardial infarction (n = 3), bleeding (n = 3), paraplegia (n = 1). Statistical significance was determined using Fisher's exact test-2 tail. Risk factors for death and complication included emergency or urgent surgery (4 deaths-emergent, 2 deaths-urgent) and preoperative renal insufficiency (2 deaths; 1 dialysis) 52% of patients in a community hospital setting underwent emergent or urgent operation and this accounted for 87% of deaths and most morbidity. Mortality in elective procedures was 8%. Based on this data, we believe that thoracoabdominal aneurysm resection can be reasonably undertaken in a community-type hospital.