RUPTURED ABDOMINAL AORTIC-ANEURYSMS - A COMMUNITY EXPERIENCE

Objective: To determine the relative contribution of preoperative, ope rative, and postoperative factors to mortality in patients with ruptur ed abdominal aortic aneurysms. Design: Retrospective case series. Sett ing: Three primary care hospitals in a community setting. Patients: Ni nety-nine patients operated on for ruptured abdominal aortic aneurysms in the selected community between January 1984 and January 1992. Outc ome Measures: Preoperative, operative, and postoperative factors were subjected to univariate and multivariate analysis to determine their r elative contribution to patient mortality. Differences were considered significant at P=.05. Results: The overall in-hospital mortality rate was 57%. The independent predictors of death were patient's age, surg ical expertise, major intraoperative technical problems, hematocrit on admission, and units of red blood cells transfused during surgery (P< .05 for each). The operative mortality rate for individual surgeons ra nged from 20% to 100%. Fifteen technical errors were identified, resul ting in a 43% mortality rate. Surgeons with the highest mortality rate s had the highest incidence of iatrogenic technical problems (P>.001). Conclusions: The outcome of patients with ruptured abdominal aortic a neurysms is, in part, determined by their preoperative status; however , surgical expertise and the avoidance of technical error significantl y impact survival in patients with ruptured abdominal aortic aneurysms and should be a major focus of our attention.