title: Ruptured Abdominal Aortic Aneurysm: Prediction of Mortality From Clinical Presentation and Glasgow Aneurysm Score.
abstract: OBJECTIVE
  To examine association of presenting clinical acuity and Glasgow Aneurysm Score (GAS) with perioperative and 1-year mortality.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Major tertiary care facility.
  
  
  METHODS
  Patients with ruptured abdominal aortic aneurysm (rAAA) from 2003 through 2013.
  
  
  METHODS
  Emergency repair of rAAA.
  
  
  RESULTS
  The authors reviewed outcomes after stable versus unstable presentation and by GAS. Unstable presentation included hypotension, cardiac arrest, loss of consciousness, and preoperative tracheal intubation. In total, 125 patients (40 stable) underwent repair. Perioperative mortality rates were 41% and 12% in unstable and stable patients, respectively (p<0.001). Unstable status had 88% sensitivity and 41% specificity for predicting perioperative mortality. Using logistic regression, higher GAS was associated with perioperative mortality (p<0.001). Using receiver operating characteristic analysis, the area under the curve was 0.72 (95% CI, 0.62-0.82) and cutoff GAS≥96 had 63% and 72% sensitivity and specificity, respectively. Perioperative mortality for GAS≥96 was 51% (25/49), whereas it was 20% (15/76) for GAS≤95. The estimated 1-year survival (95% CI) was 75% (62%-91%) for stable patients and 48% (38%-60%) for unstable patients. Estimated 1-year survival (95% CI) was 23% (13%-40%) for GAS≥96 and 77% (67%-87%) for GAS≤95.
  
  
  CONCLUSIONS
  Clinical presentation and GAS identified patients with rAAA who were likely to have a poor surgical outcome. GAS≥96 was associated with poor long-term survival, but>20% of these patients survived 1 year. Thus, neither clinical presentation nor GAS provided reliable guidance for decisions regarding futility of surgery.
authors.affiliation: Department of Anesthesiology and. Electronic address: weingarten.toby@mayo.edu.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.affiliation: Department of Anesthesiology and.
authors.forename: Lauren T
authors.initials: LT
authors.lastname: Thompson
authors.affiliation: Department of Anesthesiology and.
authors.forename: Lauren K
authors.initials: LK
authors.lastname: Licatino
authors.affiliation: Division of Pulmonary Medicine, Mayo Clinic, Scottsdale, AZ.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Bailey
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.affiliation: Department of Anesthesiology and.
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery; D001019:Aortic Rupture / Q000401:mortality* / Q000601:surgery; D005260:Female; D023261:Glasgow Outcome Scale; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012769:Shock / Q000150:complications / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
keywords: Glasgow Aneurysm Score; abdominal/mortality/surgery; aged patients; aortic aneurysm; aortic rupture/mortality/surgery; modified; postoperative complications/mortality; sensitivity and specificity