Ruptured abdominal aortic aneurysms: analysis of factors influencing surgical results in 184 patients.

BACKGROUND

Rupture is often the first manifestation in patients with abdominal aortic aneurysms. Although elective surgery for non-ruptured abdominal aortic aneurysms has provided satisfactory surgical results, operative mortality of ruptured abdominal aortic aneurysms (rAAA) has not improved. The purpose of this study was to identify predictors for early hospital death in patients with rAAA.

DESIGN

A retrospective study.

SETTING

A university hospital and 20 affiliated hospitals.

PATIENTS

PATIENTS undergoing surgical treatment for rAAA (n=183) between 1968 and 1997.

INTERVENTIONS

All patients were surgically treated and divided into operative survivors (n=119) and non-survivors (n=64).

MEASURES

The patient-related, procedure-related, and postoperative factors were compared between the two groups. A multivariate analysis was also conducted to determine predictors for hospital deaths.

RESULTS

In univariate analysis, age at operation (p=0.004), preoperative hemodynamic conditions (p<0.0001), extent of hematoma (p<0.0001), preexistent renal dysfunction (p=0.001), and volumes of blood loss at operation (p=0.001) were significantly different between the two groups. The morbidity of postoperative renal failure (p<0.0001), gut ischemia (p=0.003), heart failure or ischemic heart disease (p<0.0001), and multiple organ dysfunction syndrome (p<0.0001) was higher in the non-survivors' group. Multivariate analysis also identified preoperative hemodynamic conditions, blood loss volume at operation, pre-existent renal dysfunction, postoperative renal failure, heart failure, and multiple organ dysfunction syndrome as incremental risk factors for hospital deaths.

CONCLUSIONS

Every effort to maintain preoperative hemodynamic conditions, to reduce volumes of blood loss at operation, and to minimize deterioration of organ functions postoperatively is all essential to improve patient survival.