Prognostic factors in the surgical treatment of ruptured abdominal aortic aneurysms

Although the operative mortality following elective aneurysmectomy has achi eved satisfactory results, that following surgery for ruptured abdominal ao rtic aneurysms (AAAs) remains high. The purpose of this study was to identi fy the factors affecting the mortality rate associated with the treatment o f ruptured AAAs. Between 1978 and 1999, 33 patients underwent emergency sur gery for a ruptured AAA. The operative mortality was 33.3% and in-hospital mortality was 6.0%. Hypotension, defined as a systolic blood pressure <80mm Hg, was seen in 19 patients at the time of presentation, 9 of whom underwen t surgery in this state. In the remaining 10 patients, it was possible to i ncrease the systolic blood pressure to greater than or equal to 80mmHg preo peratively. Of the 11 patients who died within 30 days of surgery, 9 had hy potension at the time of induction of anesthesia and only 2 had a systolic blood pressure of greater than or equal to 80 mmHg. A satisfactory outcome was achieved in patients whose condition met the following criteria: a syst olic blood pressure greater than or equal to 80mmHg at the time of operatio n, minimal aortic cross-clamping time, less blood loss and blood transfusio ns, and a shorter operation time to repair the ruptured AAA. Concomitant he art disease was also found to be an important prognostic factor.