Yonsei Med J.  2012 Jul;53(4):772-780. 10.3349/ymj.2012.53.4.772.

Predictors of Postoperative Mortality of Ruptured Abdominal Aortic Aneurysm: A Retrospective Clinical Study

• Kim SD
• Hwang JK
• Park SC
• Kim JI
• Moon IS
• Park JS
• Yun SS

• KMID: 1716877
• DOI: http://doi.org/10.3349/ymj.2012.53.4.772

Abstract

PURPOSE
Despite significant improvements in surgery, anesthesia, and postoperative critical care, the postoperative mortality rate of ruptured abdominal aortic aneurysm (RAAA) has remained at 40% to 50% for several decades. Therefore, we evaluated factors associated with the postoperative mortality of RAAA.
MATERIALS AND METHODS
From January 1999 to December 2008, a retrospective study was performed with 34 patients who underwent open repair of RAAA. The preoperative factors included age, sex, smoking, comorbidities, serum creatinine, hemoglobin, shock, pulse rate, and time from emergency room to operation room. The intraoperative factors included blood loss, transfusion, aortic clamping site and time, aneurysmal characteristics, rupture type, graft type, hourly urine output (HUO), and operative time. The postoperative factors included inotropic support, renal replacement therapy (RRT), reoperation, bowel ischemia, multiple organ failure (MOF), and intensive care unit stay. The 2-day and the 30-day mortality rates were analyzed separately.
RESULTS
The 2-day and the 30-day mortality rates were 14.7% and 41.2%, respectively. On univariate analysis, shock, transfusion, HUO, inotropic support and MOF for the 2-day mortality and serum creatinine, transfusion, aortic clamping site, HUO, inotropic support, RRT and MOF for the 30-day mortality were statistically significant. On multivariate analysis, shock, inotropic support and MOF for the 2-day mortality and aortic clamping site, RRT and MOF for the 30-day mortality were statistically significant.
CONCLUSION
To decrease the postoperative mortality rate of RAAA, prevention of massive hemorrhage and acute renal failure with infrarenal aortic clamping, as well as prompt operative control of bleeding and maintenance of systemic perfusion are important.

Keyword

Abdominal aortic aneurysm; ruptured; postoperative mortality

MeSH Terms

Aged
Aortic Rupture/*mortality/*surgery
Female
Humans
Male
Middle Aged
Postoperative Complications/*mortality
Postoperative Period
Retrospective Studies

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