The post-operative mortality of ruptured abdominal aortic aneurysm repair.
BACKGROUND
Late peri-operative death after ruptured abdominal aortic aneurysm (RAAA) repair is usually due to multiple-organ failure. The aim of this study was to identify any factors that are associated with mortality in this group of patients.


METHODS
A retrospective case-note review of a single decade's operative experience of RAAA repair in a single centre. Only those patients with confirmed rupture at laparotomy were included. Sixty-three pre- intra- and post-operative variables were recorded where possible for each patient who survived surgery and the initial 24-hours post-operatively. Multi-variate analysis was performed using stepwise logistic regression. The P-POSSUM, RAAA-POSSUM, RAAA-POSSUM (physiology only), V-POSSUM, and V-POSSUM (physiology only) models were all compared to determine how each performed in these patients.


RESULTS
Two hundred and twenty-three cases of confirmed RAAA were identified, of whom 139 survived the operation and initial 24-hours post-operatively. In-hospital mortality in this group of patients was 32.4%. Variables significantly associated with mortality after multi-variate analysis, were low intra-operative systolic blood pressure, the presence of a consultant anaesthetist at the initial operation and the development of cardiac, renal or gastro-intestinal complications. All POSSUM models except the V-POSSUM and P-POSSUM (physiology only) models demonstrated no significant lack of fit in this dataset.


CONCLUSIONS
Factors associated with delayed peri-operative death after RAAA are not the same as those previously found to be associated with overall peri-operative mortality after RAAA repair.
Bown
M J
MJ
Department of Surgery, Leicester Royal Infirmary, University of Leicester, UK.
Cooper
N J
NJ
Sutton
A J
AJ
Prytherch
D
D
Nicholson
M L
ML
Bell
P R F
PR
Sayers
R D
RD
D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000401:mortality*