RUPTURED ABDOMINAL AORTIC-ANEURYSM - IMPACT OF COMORBIDITY AND POSTOPERATIVE COMPLICATIONS ON OUTCOME

Ruptured abdominal aortic aneurysm (AAA) remains a common and highly l ethal problem. This study evaluates the morbidity and mortality rates and aims to identify which clinical variables could predict the outcom e. We reviewed the records of 112 patients (97 men and 15 women) opera ted on for ruptured infrarenal AAA within the past 12 years (April 1, 1980, to March 31, 1992). Forty-seven clinical variables were collecte d and correlated with outcome by univariate and multivariate analysis. Mean age was 72.4 years (range 51 to 89 years). Only 12.5% were known to have an AAA before rupture. Preoperative systolic pressure <90 mm Hg was present in 84 patients (75%) and 11 patients (9.8%) experienced cardiac arrest before surgery. The in-hospital mortality rate was 49. 1% (55/112). Two preoperative variables were associated with increased mortality: systolic pressure <90 mm Hg and cardiac arrest (p = 0.04 a nd p = 0.009, respectively). Preoperative comorbidity had no impact on outcome. Massive blood loss (greater than or equal to 5000 ml) was an intraoperative factor predictive of increased mortality (p = 0.0007). After multivariate analysis, only the following five postoperative va riables were associated with increased mortality: cardiac event, renal failure requiring dialysis, coagulopathy, bleeding, and multisystem o rgan failure (all p < 0.05). We did not identify a preoperative factor that predicts certain death and allows us to deny a patient a chance at survival. The occurrence of multisystem organ failure is associated with no survivors and raises the ethical issue of withholding treatme nt for these patients in the postoperative course. We favor selective screening and aggressive elective repair to improve survival by operat ing before rupture occurs.