title: Usefulness of the Hardman index in predicting outcome after endovascular repair of ruptured abdominal aortic aneurysms.
abstract: OBJECTIVE
  The Hardman index, which has five variables, has been recommended as a predictor of outcome after open repair of ruptured abdominal aortic aneurysms (RAAAs). It has been reported that the presence of three or more variables is uniformly fatal. The aim of this study was to test the same model in an independent series of RAAA patients undergoing endovascular repair.
  
  
  METHODS
  A consecutive series of 41 patients undergoing endovascular repair for RAAA during an 8-year period was analyzed retrospectively. Thirty-day mortality and patient variables, including the five Hardman risk factors of age >76 years, serum creatinine >190 micromol/L, hemoglobin <9 g/dL, loss of consciousness, and electrocardiographic (ECG) evidence of ischemia, were recorded. The Hardman index and a revised version of the index with four variables (without ECG ischemia) were calculated and related to clinical outcome.
  
  
  RESULTS
  Operative mortality was 41% (17 of 41). On univariate analysis, only age >76 years (P = .01) and the use of local anesthesia (P < .0001) were statistically significant. Loss of consciousness (P = .05) showed a trend toward a higher mortality, albeit not statistically significant. On multivariate analysis, the use of local anesthesia was the only significant predictor of survival (odds ratio [OR], 0.03; 95% confidence interval [CI], 0.003-0.25, P = .001). Again, loss of consciousness showed an association with a higher chance of dying but did not achieve statistical significance (OR, 6.30; 95% CI, 0.93-42.51, P = .059). The original and revised versions of the Hardman index were both significantly associated with death (P = .02 and P = .001, chi(2) test for trend). The cumulative effect of 0, 1, 2, and >/=3 risk factors on mortality was 0%, 27%, 36%, and 71% for the original index, and 12.5%, 21%, 60%, and 78% for the revised version, respectively. Four and two patients with a score of >/=3 in each version of the index survived endovascular repair.
  
  
  CONCLUSIONS
  The Hardman index, with or without incorporating ECG ischemia, seems to be a simple and useful predictive tool in patients undergoing endovascular repair of RAAA, with the mortality rate increasing along with the Hardman score. However, the index cannot be used to accurately identify patients with no chance of survival after endovascular repair.
authors.affiliation: Fifth Department of Surgery, Aristotle University of Thessaloniki, Hippocrateio Hospital, Thessaloniki, Greece.
authors.forename: Christos D
authors.initials: CD
authors.lastname: Karkos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karamanos
authors.forename: Konstantinos O
authors.initials: KO
authors.lastname: Papazoglou
authors.forename: Alexandros S
authors.initials: AS
authors.lastname: Kantas
authors.forename: Evangelia G
authors.initials: EG
authors.lastname: Theochari
authors.forename: Apostolos G
authors.initials: AG
authors.lastname: Kamparoudis
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Gerassimidis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001019:Aortic Rupture; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D015607:Stents