Predicting death from ruptured abdominal aortic aneurysms

Background: We have previously reported preoperative and immediate postoper ative formulae to estimate mortality in patients with ruptured abdominal ao rtic aneurysms (rAAA). In this study, we prospectively compared these formu lae in patients with rAAA with their actual outcomes. Methods: Information was collected on 134 patients from two centers over a 3-year period. Preoperative mortality risk was estimated using coefficients for age, level of consciousness, and cardiac arrest. Mortality risk in the immediate postoperative state was based on the presence of coagulopathy, i schemic colitis, prolonged requirement for inotropes, time from arrival at hospital to surgery, patient ape, perioperative myocardial infarction, rena l failure, and pre-operative hemoglobin level. Results: The average age was 73 years (range 30 to 92 y) and 20 of 134 (15% ) patients were women. Sixty-three patients (47%) survived. For patients wi th a calculated preoperative mortality risk of >90%, the sensitivity, speci ficity, and positive and negative predictive values were 25%, 98%, 95%, and 54%, respectively. For a mortality risk >80%, these values were 37%, 94%, 87%, and 57%, respectively. For patients with an estimated immediate postop erative mortality risk greater than or equal to 90%, the sensitivity, speci ficity, and positive and negative predictive values were 17%, 87%, 60%, and 49%, respectively. For a predicted mortality greater than or equal to 80%, these values were 22%, 84%, 60%, and 50%, respectively. Conclusions: Our formula for predicting mortality for preoperative rAAA pat ients may be useful for patients with an estimated mortality risk greater t han or equal to 90%, based on the high positive predictive value. The formu la for immediate postoperative rAAA patients was not useful in predicting d eath. (C) 2001 Excerpta Medica, Inc. All rights reserved.