A comparison of the mortality rate after elective repair of aortic aneurysms detected either by screening or incidentally

Objective: to compare predicted and actual mortality rates, using POSSUM sc oring, after elective repair of abdominal aortic aneurysms (AAAs) detected from the Gloucestershire Aneurysm Screening Programme and those discovered incidentally. Methods: a sample of 276 men undergoing elective AAA repair in Gloucestersh ire between 1991 and 1998 was studied. AAAs were either detected from the s creening programme ol were discovered incidentally and referred from other sources. Mortality data relating to these patients have been recorded prosp ectively. POSSUM scoring was performed retrospectively fi om patients' note s in both groups and related to outcome (30 day and in-hospital mortality). POSSUM and P-POSSUM methodology were used to compare observed and predicte d mortality rates. Results: in the 276 men who had elective AAA repair, the overall mortality rate was 7%. Mortality was lower in screen-detected AAAs (3/111, 3%) than A AAs discovered incidentally (16/175, 9%) (p=0.05). Preoperative physiology scores were significantly lower in men with a screen-detected AAA (median 1 9, range 13-29 ver sus 21, 12-41, p<0.001). POSSUM operative scores were si milar between the groups. Actual versus predicted death ratios in the sampl e group were more accurate using POSSUM (ratio 0.93) than P-POSSUM (2.38) a nalysis. Conclusions: men with a screen-detected AAA had a lower mortality rate afte r elective repair than in those defected incidentally; lower preoperative p hysiology scores suggested they were fitter (as well as younger). In this s tudy POSSUM analysis more accurately predicted outcome than P-POSSUM.