title: Open surgery in endovascular aneurysm repair era: simplified classification in two risk groups owing to factors affecting mortality in 137 ruptured abdominal aortic aneurysms (RAAAs).
abstract: Our objective is to identify in 137 true RAAAs operated consecutively in open surgery: (1) diagnostic therapeutic aspects capable of influencing results, (2) risk classes with different prognosis, (3) any situations where the prognosis is so negative that surgery is not recommended. The relationship of 16 anamnestic, clinical and technical parameters prospectively collected with 30-day mortality was retrospectively evaluated by uni- and multivariate analyses. Thirty-day mortality was 37%. The univariate analysis identified as mortality predictors Hb ≤ 8 g/dl and circulatory shock at hospitalisation, but following the multivariate analysis only circulatory shock was a certainly significant risk-factor. The cumulative effect on mortality of the two parameters identified at univariate analysis translates into a statistically significant difference in mortality between two groups of patients: A (no or just one risk-factor) and B (two risk-factors). To reinstate euvolemia, rather than adequate haemoglobin values, improves the chances of success. A simple prognostic index into two risk classes is feasible, but abstention from surgery is not justified in any type of patient.
authors.affiliation: Department of Medical and Surgical Sciences, Unit and Chair of Vascular Surgery, Universitá degli Studi, A.O. Spedali Civili Brescia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonardelli
authors.forename: Edoardo
authors.initials: E
authors.lastname: Cervi
authors.forename: Roberto
authors.initials: R
authors.lastname: Maffeis
authors.forename: Franco
authors.initials: F
authors.lastname: Nodari
authors.forename: Maurizio
authors.initials: M
authors.lastname: De Lucia
authors.forename: Cristina
authors.initials: C
authors.lastname: Guadrini
authors.forename: Fabio
authors.initials: F
authors.lastname: Viotti
authors.forename: Nazario
authors.initials: N
authors.lastname: Portolani
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Giulini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000401:mortality* / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome