title: Ruptured abdominal aortic aneurysms: 15 years of continued experience in a southern West Virginia community.
abstract: Factors affecting survival and mortality rate of patients who present with ruptured abdominal aortic aneurysms (AAAs) at our community hospital were established in the late 1980s. During the intervening years, there have been many improvements in medical care. This study was conducted to re-examine factors affecting survival to ascertain whether improvements in care processes have led to corresponding improvements in survival. Outcomes of 73 patients who presented with ruptured AAA from 1983 to 1987 were previously reported. A retrospective chart review was conducted of 84 similar patients from 15 subsequent years. Demographic data, preoperative assessments, treatment timings, intraoperative findings, and subsequent postoperative complications were collected, analyzed, and compared to this institution's previous reported experience. Of 84 patients reviewed, 80% were male. The mean age was 72 years. Overall mortality significantly decreased from past experience (62% compared to 44%, p = 0.03). The mortality rate specifically associated with a free intraperitoneal rupture significantly decreased (97% to 63%, p < 0.001) from our previous report, while mortality for those with retroperitoneal rupture was relatively unchanged. Patients at increased risk in the present series were those aged >70 years and had preoperative hemoglobin of <10, preoperative hematocrit of <28, and an initial emergency department systolic blood pressure of <120 in contrast to patients aged >80 and with hemoglobin of <8 in the previously reported series. Syncope, delays in beginning surgical treatment, and amount of blood loss were not significantly associated with death as had been reported previously. Type of rupture and preoperative hemoglobin were the two factors most significantly associated with death (p < 0.05 by logistic regression). Despite the improvements in patient care and knowledge of the problem, many patients (44%) still die from ruptured AAAs, and 70% of this mortality occurs during the first 24 hr. Type of rupture continues to be an important predictor of mortality, and a large amount of improvement in mortality can be attributed to improvements in treating free intraperitoneal ruptures. Treating physicians have not gained much control over factors significantly affecting mortality, but a refinement of the known factors affecting survival may help target interventions and tailor patient care. Improved prerupture treatments of aneurysms by elective operations are still essential for reducing fatal outcomes.
authors.affiliation: Department of Vascular Surgery, University of South Florida, Tampa, FL, USA.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Stone
authors.forename: J David
authors.initials: JD
authors.lastname: Hayes
authors.forename: Ali F
authors.initials: AF
authors.lastname: AbuRahma
authors.forename: J Michelle
authors.initials: JM
authors.lastname: Jackson
authors.forename: Angelo N
authors.initials: AN
authors.lastname: Santos
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Flaherty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000401:mortality* / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D006400:Hematocrit; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D014903:West Virginia / Q000453:epidemiology