RUPTURED ABDOMINAL AORTIC-ANEURYSMS - WHO SHOULD BE OFFERED SURGERY

Purpose: Operation for ruptured abdominal aortic aneurysm is generally still associated with a high mortality rate. A review of our experien ce over a 9-year period was undertaken to identify factors present on admission associated with 30-day operative mortality. Methods: A retro spective analysis of 154 patients with ruptured abdominal aortic aneur ysm submitted for operation in a university teaching hospital between January 1985 and December 1993 was undertaken. Results: The hospital m ortality rate was 39%. Logistic regression identified a set of five in dependent preoperative factors associated with mortality: age (> 76 ye ars), creatinine level (> 0.19 mmol/L), loss of consciousness after ar rival, Hb (< 9 g%), and electrocardiographic ischemia. In the 52 patie nts with a single risk factor present, the mortality rate was 37%, wit h two factors (32 patients) it was 72%, with three or more factors (8 patients), it was 100%, and no patient had all five risk factors. A 16 % mortality rate was found in the 62 patients with no risk factors. Co nclusion: These risk factors can be easily determined on admission and may be used to help improve patient selection for surgical interventi on. The current operative mortality rate for ruptured abdominal aortic aneurysm remains high, and in some cases health care resources are us ed in a nonproductive fashion. Restricted patient selection and alloca tion of scarce resources will bring advantages to both the patient and the community.