Premorbid function, comorbidity, and frailty predict outcomes after ruptured abdominal aortic aneurysm repair.
OBJECTIVE
Strategies to improve outcomes for patients with ruptured abdominal aortic aneurysm (rAAA) are becoming more evident. The aging population, however, continues to make the decision to intervene often difficult, especially given that traditional risk models do not reflect issues of aging and frailty. This study aimed to integrate measures of function alongside comorbidity- and frailty-specific factors to determine outcome.


METHODS
Patients treated for a rAAA between January 2006 and April 2014 were assessed. Demographics, mortality, and requirement for care after discharge as well as a variety of measures of function (physical, social, and psychological) and comorbidity were recorded. The primary outcome was 1-year mortality. Outcome models were generated using multivariate logistic regression and were compared with models of vascular frailty and AAA-related outcome.


RESULTS
Of 184 patients treated, 108 (59%) underwent an open surgical repair. The overall 30-day and 1-year mortality were 21.5% and 31.4%, respectively, with an overall median hospital length of stay of 13 days (interquartile range, 6-27 days). An optimal logistic regression model for 12-month mortality used Katz score, Charlson score, number of admission medicines, visual impairment, hearing impairment, hemoglobin level, and statin use as predictors, achieving an area under the receiver operating characteristic curve of 0.84.


CONCLUSIONS
This novel rAAA model incorporating function and comorbidity offers good predictive power for mortality. It is quick to calculate and may ultimately become helpful for both counseling and selection of patients and comparative audit at a time when outcome in patients with rAAA increasingly comes under the spotlight.
Department of Vascular Surgery, Addenbrookes Hospital, Cambridge, United Kingdom.
Anandagopal
A
Srinivasan
Department of Vascular Surgery, Addenbrookes Hospital, Cambridge, United Kingdom.
Graeme K
GK
Ambler
Department of Vascular Surgery, Addenbrookes Hospital, Cambridge, United Kingdom.
Paul D
PD
Hayes
Department of Vascular Surgery, Addenbrookes Hospital, Cambridge, United Kingdom.
Mohammed M
MM
Chowdhury
Department of Vascular Surgery, Addenbrookes Hospital, Cambridge, United Kingdom.
Sam
S
Ashcroft
Department of Vascular Surgery, Addenbrookes Hospital, Cambridge, United Kingdom.
Jonathan R
JR
Boyle
Department of Vascular Surgery, Addenbrookes Hospital, Cambridge, United Kingdom. Electronic address: patrick.coughlin@addenbrookes.nhs.uk.
Patrick A
PA
Coughlin
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019540:Area Under Curve; D015897:Comorbidity; D057286:Electronic Health Records; D005260:Female; D016330:Frail Elderly; D006304:Health Status; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D010351:Patient Discharge; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality