PREDICTORS OF DEATH IN NONRUPTURED AND RUPTURED ABDOMINAL AORTIC-ANEURYSMS

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.