Ruptured abdominal aortic aneurysms. A community experience.
OBJECTIVE
To determine the relative contribution of preoperative, operative, and postoperative factors to mortality in patients with ruptured abdominal aortic aneurysms.


METHODS
Retrospective case series.


METHODS
Three primary care hospitals in a community setting.


METHODS
Ninety-nine patients operated on for ruptured abdominal aortic aneurysms in the selected community between January 1984 and January 1992.


METHODS
Preoperative, operative, and postoperative factors were subjected to univariate and multivariate analysis to determine their relative contribution to patient mortality. Differences were considered significant at P = .05.


RESULTS
The overall in-hospital mortality rate was 57%. The independent predictors of death were patient's age, surgical expertise, major intraoperative technical problems, hematocrit on admission, and units of red blood cells transfused during surgery (P < .05 for each). The operative mortality rate for individual surgeons ranged from 20% to 100%. Fifteen technical errors were identified, resulting in a 43% mortality rate. Surgeons with the highest mortality rates had the highest incidence of iatrogenic technical problems (P > .001).


CONCLUSIONS
The outcome of patients with ruptured abdominal aortic aneurysms is, in part, determined by their preoperative status; however, surgical expertise and the avoidance of technical error significantly impact survival in patients with ruptured abdominal aortic aneurysms and should be a major focus of our attention.
Katz
S G
SG
Department of Surgery, Huntington Memorial Hospital, Pasadena, CA.
Kohl
R D
RD
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D002983:Clinical Competence; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome