Serious complications are common after elective open AAA repair, and we have shown for the first time that a restricted perioperative fluid regimen can prevent MC and significantly reduce overall hospital stay.
Background & Objectives:The aim of this study was to apply three simple risk -scoring systems to prospectively collected data on all elective open Abdominal Aortic Aneurysm (AAA) operations in the Cambridge Academic Vascular Unit over a 6 -year period (January 1998 to January 2004), to compare their predictive values and to evaluate their validity with respect to prediction of mortality and post-operative complications.Methods: 204 patients underwent elective open infra-renal AAA repair. Data were prospectively collected and risk assessment scores were calculated for mortality and morbidity according to the Glasgow Aneurysm Score (GAS), VBHOM (Vascular Biochemistry and Haematology Outcome Models) and Estimation of Physiologic Ability and Surgical Stress (E-PASS).Results: The mortality rate was 6.3% (13/204) and 59% (121/204) experienced a post-operative complication (30-day outcome). For GAS, VB-HOM and E-PASS the receiver operating characteristics (ROC) curve analysis for prediction of in-hospital mortality showed area under the curve (AUC) of 0.84 (95% confidence interval [CI], 0.76 to 0.92; pϽ0.0001), 0.82 (95% CI, 0.68 to 0.95; pϭ0.0001) and 0.92 (95% CI, 0.87 to 0.97; pϽ0.0001) respectively. There were also significant correlations between post-operative complications and length of hospital stay and each of the three scores, but the correlation was substantially higher in the case of E-PASS.Conclusions: All three scoring systems accurately predicted the risk of mortality and morbidity in patients undergoing elective open AAA repair.
Serious complications are common after elective open AAA repair, and we have shown that positive fluid balance is predictive of major adverse events increased HDU/ICU and overall hospital stay.
Objective: Military vascular injuries are complex limb and life-threatening wounds which pose significant difficulties in pre-hospital and surgical management. Our aim was to provide a comprehensive description of the epidemiology, treatment and outcome of vascular injury amongst service personnel deployed on operations in Afghanistan and Iraq. Method: Analysis of the British Military Trauma Registry was combined with hospital record and post-mortem review of all cases of vascular trauma in deployed service personnel over a 5-year period ending in January 2008. Results: Of 1203 trauma patients, 121 sustained injuries to named vessels. Seventy-seven of 121 died prior to any opportunity for surgical intervention. All 19 patients who sustained an injury to a named vessel in the abdomen or thorax died; 18 did not survive to undergo surgery, one in extremis casualty underwent a thoracotomy and died. Six out of 15 patients with cervical vascular injuries survived to surgical intervention; two died following surgery. Of 87 patients with extremity vascular injuries, 37 survived to surgery with two postoperative deaths. Interventions on 38 limbs included 19 damage control (15 primary amputations, four vessel ligations) and 19 definitive limb revascularisation procedures (11 interposition vein grafts, eight direct repairs) of which four failed, necessitating three amputations. Conclusion: In operable patients with extremity injury, amputation or ligation is often required for damage control and preservation of life, but favourable limb salvage rates are achievable in casualties able to withstand revascularisation. Despite marked progress in contemporary battle-field trauma care, torso vascular injury is usually not amenable to surgical intervention.
Trends in hospital abdominal aortic aneurysm deaths in Scotland over 10 years,
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