Treatment of ruptured abdominal aortic aneurysm, a permanent challenge or a waste of resources? Prediction of outcome using a multi-organ-dysfunctionscore

Objectives: in a retrospective study, attempts have been made to identify i ndividual organ-dysfunction risk profiles influencing the outcomes after su rgery for ruptured abdominal aortic aneurysms. Methods: out of 235 patients undergoing graft replacement for abdominal aor tic aneurysms, 57 (53 men, four women, mean age 72 years [S.D. 8.8]) were t reated for ruptured aneurysms in a 3-year period. Forty-eight preoperative, 13 intraoperative and 34 postoperative variables were evaluated statistica lly. A simple multi-organ dysfunction (MOD) score was adopted. Results: the perioperative mortality was 32%. Three patients died intraoper atively, four within 48 h and 11 died later. A significant influence for pr e-existing risk factors was identified only for cardiovascular diseases. Mu ltiple linear-regression analysis indicated that a haemoglobin <90 g/l, sys tolic blood pressure <80 mmHg and ECG signs of ischaemia at admission were highly significant risk factors. The cause of death for patients, who died more than 48 h postoperatively, was mainly MOD. All patients with a MOD sco re greater than or equal to 4 died (n = 7). These patients required 27% of the intensive-care unit (ICU) days of all patients and 72% of the ICU days of the non-survivors. Conclusion: patients with ruptured aortic aneurysms from treatment should n ot be excluded. However, a physiological scoring system after 48 h appears justifiable in order to decide on the appropriateness of continual ICU supp ort.