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Ruptured abdominal aortic aneurysms: factors influencing postoperative mortality and long-term survival
H P van Dongen1, J A Leusink, F L Moll
1Department of Anaesthesiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Objective:
To update mortality rates and long-term survival of patients admitted to the hospital with ruptured abdominal aortic aneurysm (AAA) and to study prognostic factors associated with mortality.
Design:
Retrospective follow-up.
Materials:
309 patients (274 men, 35 women, average age 71) admitted to the hospital between January 1980 and January 1994 who were surgically treated for ruptured AAA were studied.
Methods:
To identify the preoperative (9), intraoperative (23) and postoperative (49) variables associated with mortality logistic regression analysis (mortality within 48 h) and Cox regression analysis (mortality between 48 h and 30 days) were performed.
Results:
Hospital mortality improved from 1980 to 1994. Compared with the normal population adjusted for age and sex the long-term mortality rate was increased (standardised mortality ratio 2.1; 95% confidence interval 1.7-2.5). Increased age, peroperative hypotension and need for a bifurcated graft were associated with significantly increased mortality. Co-morbidity was not a predictive variable. Overall hospital mortality was 25%.
Conclusion:
Surgical repair of ruptured AAA should be considered even in patients with co-morbidity. Elderly patients with severe preoperative hypotension have a very high mortality rate and surgery may not be justified in these cases. Long-term survival is also worse in older patients.