title: Predictors affecting in-hospital mortality of ruptured abdominal aortic aneurysms: a Greek multicenter study.
abstract: BACKGROUND
  Endovascular aortic repair (EVAR) is being used with increasing frequency for the treatment of ruptured abdominal aortic aneurysms (rAAAs), although conflicting results have been reported concerning perioperative mortality. The aim of our study was to evaluate potential difference in mortality rates between EVAR and open surgical repair (OSR) and identify independent risk factors for in-hospital mortality in rAAAs. This study also aimed to evaluate the Glasgow Aneurysm Score (GAS) in predicting in-hospital mortality. A time-trend analysis of EVAR for ruptured AAAs was also performed.
  
  
  METHODS
  Prospectively collected data from 7 public hospitals in Greece concerning rAAA repairs between January 2006 and April 2012 were analyzed. Primary outcome was in-hospital mortality. Multivariate logistic regression analysis was used to identify independent risk factors. The receiver-operator characteristic curve was used to determine the value of the GAS in predicting in-hospital death. Time-trend analysis, depicting annual changes (%), concerning EVAR for ruptured AAAs was also conducted.
  
  
  RESULTS
  A total of 418 patients (92.3% men, mean age = 74.3 ± 8.8) with rAAAs were recorded during the study period. Among them, 113 patients (27%) underwent EVAR. Overall in-hospital mortality was 45.2%, whereas in-hospital mortality after EVAR and OSR was 20.4% and 54.3%, respectively (P < 0.001). Multivariate analysis evidenced that hemodynamic instability (P < 0.001), OSR (P < 0.001), age ≥80 years (P < 0.001), coronary artery disease (P < 0.001), and renal insufficiency (P = 0.02) independently increased in-hospital mortality. Area under the curve of GAS was 0.80 (95% confidence interval [CI] = 0.75-0.85, P < 0.001) for OSR and 0.64 (95% CI = 0.51-0.77, P = 0.04) for EVAR. Annual increase of proportion (%) of EVAR for rupture was 5% (P = 0.004).
  
  
  CONCLUSIONS
  EVAR is being used with increasing frequency for the treatment of rAAAs and it appears to be associated with lower in-hospital mortality compared with OSR, after adjustment for hemodynamic instability and known atherosclerotic risk factors. Preoperative predictors of in-hospital mortality such as GAS should be probably modified in these patients.
authors: Department of Vascular Surgery, University General Hospital "Attikon", Athens, Greece. Electronic address: kostas.antonopoulos@gmail.com.
authors: Constantine N
authors: CN
authors: Antonopoulos
authors: Department of Vascular Surgery, University General Hospital "Attikon", Athens, Greece.
authors: John D
authors: JD
authors: Kakisis
authors: General Hospital "Korgialenio - Benakio National Red Cross", Athens, Greece.
authors: Vasilios
authors: V
authors: Andrikopoulos
authors: General Hospital "Konstantopoulio - Agia Olga", Athens, Greece.
authors: Konstantinos
authors: K
authors: Dervisis
authors: General Hospital "Laikon", Athens, Greece.
authors: Sotirios
authors: S
authors: Georgopoulos
authors: University Hospital of Larissa, Larissa, Greece.
authors: Athanasios
authors: A
authors: Giannoukas
authors: General Hospital of Thessaloniki "Papageorgiou", Thessaloniki, Greece.
authors: Dimitrios
authors: D
authors: Kiskinis
authors: 3rd Surgical Department, University General Hospital "Attikon", Athens, Greece.
authors: Anastasios
authors: A
authors: Machairas
authors: General Hospital "Sismanoglio", Athens, Greece.
authors: Vasilios
authors: V
authors: Papavassiliou
authors: Department of Vascular Surgery, University General Hospital "Attikon", Athens, Greece.
authors: Christos D
authors: CD
authors: Liapis
authors: Pavlos
authors: P
authors: Antoniadis
authors: Nikolaos
authors: N
authors: Bessias
authors: Triantafillos G
authors: TG
authors: Giannakopoulos
authors: Elias
authors: E
authors: Kaperonis
authors: Christos
authors: C
authors: Klonaris
authors: Vasilios
authors: V
authors: Saleptsis
authors: Nikolaos
authors: N
authors: Saratzis
authors: Konstantinos
authors: K
authors: Seretis
authors: Charalambos
authors: C
authors: Tampakis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019540:Area Under Curve; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D003661:Decision Support Techniques; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006115:Greece; D006439:Hemodynamics; D017052:Hospital Mortality; D006779:Hospitals, Public; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome