title: Treatment of ruptured abdominal aortic aneurysm, a permanent challenge or a waste of resources? Prediction of outcome using a multi-organ-dysfunction score.
abstract: OBJECTIVE
  in a retrospective study, attempts have been made to identify individual organ-dysfunction risk profiles influencing the outcome after surgery for ruptured abdominal aortic aneurysms.
  
  
  METHODS
  out of 235 patients undergoing graft replacement for abdominal aortic aneurysms, 57 (53 men, four women, mean age 72 years [s.d. 8.8]) were treated for ruptured aneurysms in a 3-year period. Forty-eight preoperative, 13 intraoperative and 34 postoperative variables were evaluated statistically. A simple multi-organ dysfunction (MOD) score was adopted.
  
  
  RESULTS
  the perioperative mortality was 32%. Three patients died intraoperatively, four within 48 h and 11 died later. A significant influence for pre-existing risk factors was identified only for cardiovascular diseases. Multiple linear-regression analysis indicated that a haemoglobin <90 g/l, systolic blood pressure <80 mmHg and ECG signs of ischaemia at admission were highly significant risk factors. The cause of death for patients, who died more than 48 h postoperatively, was mainly MOD. All patients with a MOD score >/=4 died (n=7). These patients required 27% of the intensive-care unit (ICU) days of all patients and 72% of the ICU days of the non-survivors.
  
  
  CONCLUSIONS
  patients with ruptured aortic aneurysms from treatment should not be excluded. However, a physiological scoring system after 48 h appears justifiable in order to decide on the appropriateness of continual ICU support.
authors.affiliation: Department of Vascular Surgery, Clinic of Thoracic, Cardiac and Vascular Surgery, Switzerland.
authors.forename: H W
authors.initials: HW
authors.lastname: Kniemeyer
authors.forename: T
authors.initials: T
authors.lastname: Kessler
authors.forename: P U
authors.initials: PU
authors.lastname: Reber
authors.forename: H B
authors.initials: HB
authors.lastname: Ris
authors.forename: H
authors.initials: H
authors.lastname: Hakki
authors.forename: M K
authors.initials: MK
authors.lastname: Widmer
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000401:mortality* / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000145:classification* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome