Ruptured abdominal aortic aneurysms--prognostic indicators and complications affecting mortality. A local experience.
Although elective abdominal aortic aneurysm (AAA) repair can be done with a less than 5% mortality rate, ruptured AAAs have a 32-85% mortality rate. The aims of this study were: (i) to identify prognostic factors affecting mortality; (ii) to identify and assess the impact of postoperative complications on mortality; and (iii) to try to identify a subgroup of patients who would not benefit from surgery. The records of 54 patients presenting with ruptured AAAs were reviewed; 49 of these patients were operated on, 43 of them males and 6 females (mean age 67 years). The operative mortality rate was 44%, most patients who died doing so in the intensive care unit. In 14 cases AAA was diagnosed before rupture--6 of these patients died. Factors that had a significant effect on mortality were: (i) associated ischaemic heart disease--83% of these patients died postoperatively; (ii) the degree of shock on admission--66% of patients with a blood pressure on admission of 85 mmHg or less died; and (iii) the number of postoperative complications per patients--those with 2 or more complications had an 83% mortality rate. Factors that did not correlate statistically with mortality were age, time interval to surgery, volume and composition of intra-operative fluid therapy, and length of surgery. The most important correctable error was failure to operate electively. From the factors assessed it was not possible clearly to identify a subgroup of patients in this study who should have been excluded from surgery.
Browning
N G
NG
Department of Surgery, University of the Orange Free State, Bloemfontein.
Long
M A
MA
Barry
R
R
Nel
C J
CJ
Schall
R
R
Monk
E
E
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000601:surgery; D001019:Aortic Rupture / Q000150:complications* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors