STRATIFICATION OF MORTALITY RISK FOR RENAL-ARTERY SURGERY

Seventy consecutive operations involving the renal arteries were revie wed to identify factors linked to perioperative mortality. Aortorenal bypass (n=29), endarterectomy (n=12), extraanatomic bypass (n=12), thr ombectomy (n=4), and reimplantation (n=13) were associated with a 16% perioperative mortality that was often secondary to multisystem organ failure. Patients who died exhibited a higher serum creatinine (3.4 vs 2.1 mg/dL; P<0.05). Stratification of patients by risk revealed highe r American Society of Anesthesiologists (ASA) (P<0.005) and modified A cute Physiology Score, and Chronic Health Evaluation (APACHE II) (P<0. 02) score among patients who died. Higher mortality was also observed after bilateral renal artery operations (31% vs 5%; P<0.005) or concom itant mesenteric revascularization (37% vs 12%; P<0.05), but not simul taneous aortic procedures (18% vs 11%; P=NS). Bilateral operation (P<0 .0001), age (P<0.001), and ASA class (P<0.01) were independent predict ors of mortality according to multivariate analysis. Because of higher mortality in these specific situations, modification or limitation of operative scope may be appropriate.