Prolonged ventilation, perioperative myocardial infarction, a history of peripheral vascular disease, preoperative renal dysfunction, and a history of congestive heart failure are independent predictors of perioperative death in patients with nonruptured AAAs. For patients with ruptured AAAs, mortality rates can be estimated before surgery using age, level of consciousness, and cardiac arrest. For patients who survive the initial surgery for ruptured AAA, subsequent mortality rates can also be predicted.

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A retrospective review of 106 cases of ruptured abdominal aortic aneurysm was undertaken to determine whether analysis of preoperative variables might be predictive of death in this condition. Thirty variables were analyzed by univariate and multivariate methods. Statistically significant differences between survivors and nonsurvivors were noted for 12 of 30 factors when analyzed with univariate tests. Multivariate analysis with stepwise logistic regression demonstrated that elevation of the unmeasured anion gap, a history of congestive heart failure, and the patient's level of consciousness before operation were significantly and independently associated with death. Coefficients generated from this model allowed stratification of patients into four risk groups with respective mortality rates of 100%, 75%, 28%, and 12%. We conclude that it is possible to assign a mortality risk score to individual cases of ruptured abdominal aortic aneurysm on the basis of readily available clinical and laboratory parameters. A prospective study to address this question seems justified.

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