Identification of Risk Factors and Development of Predictive Risk Score Model for Mortality after Open Ruptured Abdominal Aortic Aneurysm Repair

Abstract

Background and Objectives: Despite the relatively large number of publications concerning the validation of these models, there is currently no solid evidence that they can be used with absolute precision to predict survival. The goal of this study is to identify preoperative factors that influenced 30-day mortality and to create a predictive model after open ruptured abdominal aortic aneurysm (RAAA) repair. Materials and Methods: This was a retrospective single-center cohort study derived from a prospective collected database, between 1 January 2009 and 2016. Multivariate logistic regression analysis was used to identify all significant predictive factors. Variables that were identified in the multivariate analysis were dichotomized at standard levels, and logistic regression was used for the analysis. To ensure that dichotomized variables were not overly simplistic, the C statistic was evaluated for both dichotomized and continuous models. Results: There were 500 patients with complete medical data included in the analysis during the study period. Of them, 37.6% were older than 74 years, and 83.8% were males. Multivariable logistic regression showed five variables that were predictive of mortality: age > 74 years (OR = 4.01, 95%CI 2.43–6.26), loss of consciousness (OR = 2.21, 95%CI 1.11–4.40), previous myocardial infarction (OR = 2.35, 95%CI 1.19–4.63), development of ventricular arrhythmia (OR = 4.54, 95%CI 1.75–11.78), and DAP < 60 mmHg (OR = 2.32, 95%CI 1.17–4.62). Assigning 1 point for each variable, patients were stratified according to the preoperative RAAA mortality risk score (range 0–5). Patients with 1 point suffered 15.3% mortality and 3 points 68.2% mortality, while all patients with 5 points died. Conclusions: This preoperative RAAA score identified risk factors readily assessed at the bedside and provides an accurate prediction of 30-day mortality after open repair of RAAA.

Pre-operative predictors of mortality in ruptured abdominal aortic aneurysms: is the Harborview Medical Center mortality risk score enough?

“…Recent studies using different parameters to predict post-operative mortality and/or evaluate the accuracy of the HMC score have gained prominence. In a study of 500 patients who underwent OR for rAAA by Tomic et al,[ 16 ] the most common post-operative complications were pulmonary issues, acute renal failure, and the need for surgical revision. The 30-day mortality rate was 35.4%.…”

Assessment of timely detection of abdominal aortic aneurysm in Serbian population based on the data from Serbvasc registry of operated patients

“…On the other hand, the rate of untreated patients admitted due to rAAA in Serbian hospitals is somehow lower due to local practice. 17,18 This lower incidence rate of treated AAA cases can be explained by a lower rate of detection and treatment of existing AAA. Since there is no evidence of waiting lists in Serbian hospitals when it comes to the treatment of AAA, one can assume that the lower rate of detection is the cause of this unfavorable ratio between elective and urgent procedures for treating AAA.…”