title: Risk factors affecting survival after surgical repair of ruptured abdominal aortic aneurysm.
abstract: OBJECTIVE
  The purpose of this study is to identify the risk factors affecting the high mortality rates associated with the treatment of ruptured abdominal aortic aneurysm (AAA).
  
  
  METHODS
  In this retrospective study, the subjects consisted of 105 patients who underwent repair of ruptured AAA at our institution from December 1984 to March 2012. We compared the patients of ruptured AAA in survival group with those in death group to evaluate the clinical factors in ruptured AAA mortality.
  
  
  RESULTS
  The operative and in-hospital mortality of ruptured AAA patients was 22.9% compared with 1.9% for that of non-ruptured AAA patients. The mean hemoglobin level was significantly lower in death group than in survival group. Intraoperative bleeding volume was significantly higher in death group than in survival group. Cox proportional hazard analysis showed that level 3 or 4 according to the Rutherford classification, preoperative hemoglobin level of less than 9.0 g/dl, intraoperative blood loss volume of more than 3000 ml, postoperative bowel ischemia and class 3 or 4 according to the Fitzgerald classification were significantly associated with high mortality.
  
  
  CONCLUSIONS
  These findings showed that every effort to maintain preoperative hemodynamic stability reduce volumes of blood loss in operation, and to minimize postoperative deterioration of organ functions would be essential to improve patient survival.
authors.affiliation: The Division of Cardiovascular Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Hokkaido, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kunishige
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Ishibashi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kawasaki
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Morimoto
authors.forename: Nozomu
authors.initials: N
authors.lastname: Inoue
keywords: postoperative mortality; ruptured abdominal aortic aneurysm