Ruptured abdominal aortic aneurysm - Outcome in a community teaching hospital intensive care unit

Ruptured abdominal aortic aneurysm (RAAA) is a surgical emergency associate d with a high mortality often requiring postoperative intensive care. Our o bjectives were to assess the outcome of RAAA management in a non tertiary c ommunity hospital intensive care unit (ICU) and to compare this with histor ical data from tertiary hospitals. We also sought to identify variables rel ated to outcome and evaluate the potential of an organ failure score to ide ntify patients at increased risk of death. The study was a retrospective chart review of patients with RAAA over 11 ye ars (1986-1996 inclusive) at Manly District Hospital, a 210 bed community t eaching hospital with eight intensive care beds. Forty patients were identi fied in the study period as having been admitted to ICU after RAAA surgery. There was an overall hospital mortality rate of 47.5% and intensive care m ortality rate of 42.5% for successfully operated RAAA. Five variables were significantly different between survivors and non-survivors. These were age , total amount of blood products required, duration of operation, developme nt of hypotension (systolic blood pressure <90 mmHg) in ICU postoperatively , and APACHE II score at Day 1 ICU: A trend was also found between mortalit y rate and the number of failed systems after 48 hours intensive care stay. Mortality for a patient with zero failed systems was 38%, one failed syste m 42%, two 58% and three 67%. Based on these results, management of RAAA in a non-tertiary setting appear s appropriate with postoperative care occurring in an ICU where there is ad equate equipment and medical and nursing staff experienced in the care of c omplex critical illness.