Purpose: This study evaluated perioperative variables to predict-death
in nonruptured and ruptured abdominal aortic aneurysm (AAA) surgery.
Methods: A consecutive review of all patients who underwent AAA surger
y from January 1984 to December 1993 was carried out. Perioperative va
riables were analyzed with univariate and multivariate statistical mod
els to predict mortality rates. Results: Four hundred seventy-eight pa
tients with nonruptured AAAs and 157 patients with ruptured AAAs were
studied. In patients with nonruptured AAAs, the mortality rate was 3.8
%. Using stepwise logistic regression analysis, independent predictors
of death were perioperative myocardial infarction (odds ratio [OR], 5
.0; p < 0.01), prolonged postoperative ventilation (OR, 4.0; p < 0.01)
, history of peripheral vascular disease (OR, 2.9; p < 0.01), preopera
tive renal dysfunction (OR, 2.7; p < 0.01), and history of congestive
heart failure (OR, 2.6; p < 0.03). In patients with ruptured AAAs, the
mortality rate was 46%. Analysis of preoperative variables using mult
ivariate stepwise logistic regression found predictors of death to be
preoperative unconsciousness (OR, 3.1; p < 0.01), advanced age (OR, 1.
9; p < 0.01), and cardiac arrest (OR, 1.8; p < 0.05). In patients who
survived the initial surgery for ruptured ABA, a second stepwise logis
tic regression model found independent predictors for subsequent posto
perative death to be coagulation disorder (OR, 7.9; p < 0.01), ischemi
c colitis (OR, 6.4; p < 0.01), inotropic support beyond 48 hours (OR,
4.8; p < 0.01), delayed transport to operating room (OR, 4.6; p < 0.01
), advanced age (OR, 4.4; p < 0.01), perioperative myocardial infarcti
on (OR, 4.0; p < 0.05) and postoperative renal dysfunction (OR, 3.7; p
< 0.01). Conclusion: Prolonged ventilation, perioperative myocardial
infarction, a history of peripheral vascular disease, preoperative ren
al dysfunction, and a history of congestive heart failure are independ
ent predictors of perioperative death in patients with nonruptured AAA
s. For patients with ruptured AAAs, mortality rates can be estimated b
efore surgery using age, level of consciousness, and cardiac arrest. F
or patients who survive the initial surgery for ruptured AAA, subseque
nt mortality rates can also be predicted.