Role of the Hardman index in predicting mortality for open and endovascular repair of ruptured abdominal aortic aneurysm.
OBJECTIVE
To correlate the Hardman prognostic index with perioperative mortality in patients undergoing open and endovascular repair of ruptured abdominal aortic aneurysm (rAAA).


METHODS
Over a 5-year period, 126 patients (109 men; mean age 74 years, range 51-91) underwent open (n=74) or endovascular (n=52) repair of rAAA in a single unit. Five Hardman factors (age>76 years, history of loss of consciousness, ECG evidence of ischemia, hemoglobin<9.0 g/dL, and serum creatinine>0.19 mmol/L) were assessed, and their association with in-hospital or 30-day mortality was evaluated retrospectively by chi-square or logistic regression analysis.


RESULTS
The mortality for open repair was 51.4% (38/74) in comparison to 32.7% (17/52) for the endovascular group (p=0.05). On multivariate analysis, loss of consciousness (p=0.03, OR 2.9, 95% CI 1.1 to 7.5) was the only significant predictor of mortality in both groups. The mortality rates for open repair patients with Hardman scores<2 were 43.5% (20/46) in comparison to 22.9% (8/35) for the endovascular group (p=0.06), whereas mortality rates for patients with scores>or=2 were 64.3% (18/28) and 52.9% (9/17) for the respective groups (p=0.54).


CONCLUSIONS
The Hardman index correlates well with mortality in both the open and endovascular groups. Those with a score<2 have a trend toward better survival following endovascular repair compared to open repair, while this benefit is not obvious in patients with a score>or=2.
Sharif
Muhammad Anees
MA
Department of Vascular and Endovascular Surgery, Belfast City Hospital, Northern Ireland, UK. aneessharif@yahoo.co.uk
Lee
Bernard
B
Makar
Ragai Reda
RR
Loan
William
W
Soong
Chee Voon
CV
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D019992:Databases as Topic; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015203:Reproducibility of Results; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome