Risk Factors Affecting Survival Rates in Patients with Ruptured Abdominal Aortic Aneurysm. New Factor, Shock Time Index.

Background and Objectives: colonic ischemia (CI) after ruptured abdominal aortic aneurysm (rAAA) repair is associated with increased morbidity and mortality. CI may be detected by using flexible sigmoidoscopy, but routine use of flexible sigmoidoscopy after rAAA is not clearly proven. The objective of this study was to evaluate the efficacy of routine flexible sigmoidoscopy in detecting CI after rAAA repair, and to identify potential hemodynamic, biochemical, and clinical variables that can predict the development of CI in the patients who underwent rAAA surgery. Materials and Methods: we retrospectively included all rAAA cases treated in Viborg hospital from 1 April 2014 until 31 August 2017, recorded the findings on flexible sigmoidoscopy, and the incidence of CI. We collected specific hemodynamic, biochemical, and clinical variables, measured pre- and perioperatively, and the first three postoperative days. The association between CI and possible predictors was analyzed in a logistic regression model. Results: a total of 80 patients underwent open rAAA repair during the study period. Flexible sigmoidoscopy was performed in 58 of 80 patients (73.5%) who survived at least 24 h after open rAAA surgery. Perioperative variables lowest arterial pH (p = 0.02) and types of operations—aortobifemoral bypass vs. straight graft (p = 0.04) showed statistically significant differences between CI groups. The analysis of the postoperative variables showed statistically significant difference in highest lactate on postoperative day 1 (p = 0.01), and lowest hemoglobin on postoperative day 2 (p = 0.04) comparing CI groups. Logistic regression model revealed that postoperative hemoglobin and lactate turned out to be independent risk factors for the development of CI (respectively OR = 0.44 (95% CI = 0.29–0.67) and OR = 1.91 (95% CI = 1.2–3.05)). Conclusions: flexible sigmoidoscopy can identify patients being at higher risk of mortality after open rAAA repair. The postoperative lactate and hemoglobin were found to be independent risk factors for the development of CI after open rAAA repair. Further larger studies are warranted to demonstrate these findings.

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Preoperative risk factors for in-hospital mortality and validity of the Glasgow aneurysm score and Hardman index in patients with ruptured abdominal aortic aneurysm

Vascular ◽

10.1258/vasc.2011.oa0313 ◽

2012 ◽

Vol 20 (3) ◽

pp. 150-155 ◽

Cited By ~ 9

Author(s):

Erol Kurc ◽

Soner Sanioglu ◽

Ayca Ozgen ◽

Serap Aykut Aka ◽

Ibrahim Yekeler

Keyword(s):

Risk Factors ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Hospital Mortality ◽

Roc Curve ◽

Scoring Systems ◽

Ruptured Abdominal Aortic Aneurysm ◽

Preoperative Risk ◽

Preoperative Risk Factors ◽

Abdominal Aortic

The aim of this study is to evaluate the validity of the Glasgow aneurysm score (GAS) and Hardman index in patients operated on because of ruptured abdominal aortic aneurysm (rAAA), and determining preoperative risk factors that affect in-hospital mortality. One hundred one patients operated on to repair a rAAA within the last 10 years were included. The GAS and Hardman index were calculated for each patient separately. The relation between in-hospital mortality and the Hardman index and GAS was analyzed by means of the receiver-operator characteristic (ROC) curve. Univariate and multivariate methods of analyses were used to determine preoperative risk factors. Average age was 69 ± 8, and in-hospital mortality rate was 51.5%. Analysis of the ROC curve showed that the Hardman index had an area under the curve (AUC) = 0.71 (95% confidence interval [CI], 0.593–0.800, P = 0.0002) for predicting in-hospital mortality. The GAS had an AUC = 0.77 (95% CI, 0.680–0.851, P < 0.0001). The results of multivariate analysis revealed the presence of the following preoperative risk factors: age more than 63 years (odds ratio [OR], 4.4; 95% CI, 1.17–16.49, P = 0.028); loss of consciousness (OR, 9.33; 95% CI, 1.94–44.86, P = 0.005); creatinine higher than 1.7 mg/dL (OR, 5.52; 95% CI, 1.92–15.85, P = 0.001); and pH lower than 7.31 (OR, 3.77; 95% CI, 1.18–11.99, P = 0.024). In conclusion, the Hardman index and GAS have a significant correlation with in-hospital mortality rates. Nevertheless, a high score does not necessarily correspond with a definite mortality. This is why scoring systems could not be considered as the sole criterion for choosing patients for this study. Clinical experience was still the leading factor in deciding against or in favor of surgery.

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Risk factors and outcomes associated with acute kidney injury following ruptured abdominal aortic aneurysm

BMC Nephrology ◽

10.1186/1471-2369-14-99 ◽

2013 ◽

Vol 14 (1) ◽

Cited By ~ 21

Author(s):

Ilana Kopolovic ◽

Kim Simmonds ◽

Shelley Duggan ◽

Mark Ewanchuk ◽

Daniel E Stollery ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Kidney Injury ◽

Ruptured Abdominal Aortic Aneurysm ◽

Abdominal Aortic

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Mortality After Elective and Ruptured Abdominal Aortic Aneurysm Surgical Repair: 12-Year Single-Center Experience of Estonia

Scandinavian Journal of Surgery ◽

10.1177/1457496917738923 ◽

2017 ◽

Vol 107 (2) ◽

pp. 152-157 ◽

Cited By ~ 5

Author(s):

J. Lieberg ◽

L.-L. Pruks ◽

M. Kals ◽

K. Paapstel ◽

A. Aavik ◽

...

Keyword(s):

Risk Factors ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Open Repair ◽

Mortality Rates ◽

Ruptured Abdominal Aortic Aneurysm ◽

Abdominal Aortic ◽

All Cause Mortality ◽

Aneurysm Repair ◽

Elective Abdominal Aortic Aneurysm

Background and Aims: Abdominal aortic aneurysm is a degenerative vascular pathology with high mortality due to its rupture, which is why timely treatment is crucial. The current single-center retrospective study was undertaken to analyze short- and long-term all-cause mortality after operative treatment of abdominal aortic aneurysm and to examine the factors that influence outcome. Material and Methods: The data of all abdominal aortic aneurysm patients treated with open repair or endovascular aneurysm repair in 2004–2015 were retrospectively retrieved from the clinical database of Tartu University Hospital. The primary endpoint was 30-day, 90-day, and 5-year all-cause mortality. The secondary endpoint was determination of the risk factors for mortality. Results and Conclusion: Elective abdominal aortic aneurysm repair was performed on 228 patients (mean age 71.8 years), of whom 178 (78%) were treated with open repair and 50 (22%) with endovascular aneurysm repair. A total of 48 patients with ruptured abdominal aortic aneurysm were treated with open repair (mean age 73.8 years) at the Department of Vascular Surgery, Tartu University Hospital, Estonia. Mean follow-up period was 4.2 ± 3.3 years. In patients with elective abdominal aortic aneurysm, 30-day, 90-day, and 5-year all-cause mortality rates were 0.9%, 2.6%, and 32%, respectively. In multivariate analysis, the main predictors for 5-year mortality were preoperative creatinine value and age (p < 0.05). In patients with ruptured abdominal aortic aneurysm, 30-day, 90-day, and 5-year all-cause mortality rates were 22.9%, 33.3%, and 55.1%, respectively. In multivariate analysis, the risk factors for 30-day mortality in ruptured abdominal aortic aneurysm were perioperative hemoglobin and lactate levels (p < 0.05). According to this study, the all-cause mortality rates of elective abdominal aortic aneurysm and ruptured abdominal aortic aneurysm at our hospital were comparable to those at other centers worldwide. Even though some variables were identified as potential predictors of survival, the mortality rates after ruptured abdominal aortic aneurysm remain high. Early diagnosis, timely treatment, and detection of the risk factors for abdominal aortic aneurysm progression would improve survival in patients with abdominal aortic aneurysm.

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