SURGICAL REPAIR OF RUPTURED ABDOMINAL AORTIC-ANEURYSMS IN THE STATE OF MARYLAND - FACTORS INFLUENCING OUTCOME AMONG 527 RECENT CASES

Purpose: Abdominal aortic aneurysm (AAA) rupture has been historically associated with high operative mortality rates. In this community-bas ed, cross-sectional study, we examined factors influencing outcome aft er operations performed for ruptured AAA (rAAA). Methods: An analysis of a state database identified 3820 patients who underwent AAA repair between 1990 and 1995, including 527 (13.8%) who had an operation for an rAAA. Demographic variables examined included patient age, gender, race, associated comorbidity rates, operative surgeon experience with rAAA, and annual hospital rAAA and total AAA operative volumes. Outcom es measured included operative mortality rates, hospital length of sta y, and charges. Results: Operative mortality rates increased significa ntly with advancing age (P < 0.0001) but were not related to gender (P = 0.474) or race (p = 0.598) and were significantly lower among patie nts with hypertension (P = 0.006) or pulmonary disease (P = 0.045); Th ere was no relationship between hospital rAAA or total AAA volume and rAAA repair mortality rate, although high-volume surgeons (i.e., perfo rming more than 10 rAAA repairs) had decreased mortality rates and hos pital charges compared with other surgeons. Hospital lengths of stay a nd charges increased with age among survivors, but not nonsurvivors, o f rAAA repair. Despite a stable incidence of rAAA repairs during the s tudy interval and no significant change in the mean age of patients un dergoing operation or the percentage of operations performed by high-v olume surgeons, the statewide mortality rate declined from 59.3% to 43 .2% (P = 0.039). Conclusion: The incidence of rAAA does not appear to be declining. Although operative rAAA repair continues to be associate d with substantial risk and remains an especially lethal condition amo ng the elderly, the operative mortality rate has declined in recent ye ars in Maryland. Lower operative mortality rates and hospital charges are associated with operations performed by high-volume surgeons.