Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Vasc Surg. 2022 Dec;76(6):1578-1587.e5. doi: 10.1016/j.jvs.2022.06.090. Epub 2022 Jul 5.
We sought to compare immediate and early mortality among patients undergoing ruptured abdominal aortic aneurysm (RAAA) repair. Evaluation of RAAA has focused on 30-day postoperative mortality. Other emergency conditions such as trauma have demonstrated a multimodal mortality distribution within the 30-day window, expanding the pathophysiologic understanding and allowing for intervention investigations with practice changing and lifesaving results. However, the temporal distribution and risk factors of postoperative morbidity and mortality in RAAA have yet to be investigated.
We evaluated factors associated with RAAA postoperative mortality in immediate (<1 day) and early (1-30 days) postoperative periods in a landmarked retrospective cohort study using data from the Vascular Quality Initiative (2010-2020).
We identified 5157 RAAA repairs (mean age, 72 ± 10 years; 77% male; 88% White; 61% endovascular). The mortality rate in the immediate period was 10.2% (528/5157) and the early mortality rate was 22.1% (918/4163). In multivariable regression analyses, signs of hemorrhagic shock (ie, hemoglobin <7 g/dL: adjusted odds ratio [aOR], 1.87 [95% confidence interval [CI], 1.14-3.06]; any preoperative systolic blood pressure <70 mm Hg: aOR, 1.40 [95% CI, 1.04-1.89]; and estimated blood loss >40%: aOR, 3.65 [95% CI, 2.29-5.83]) were associated with an increased risk of immediate mortality. Comorbid conditions (heart failure: aOR, 1.38 [95% CI, 1.00-1.92]; pulmonary disease: aOR, 1.29 [95% CI, 1.05-1.58]; elevated creatinine: aOR 1.26 [95% CI, 1.31-1.41]) were associated with increased risk of early mortality.
Immediate deaths were associated predominantly with shock from massive hemorrhage, whereas early deaths were associated with comorbid conditions predisposing patients to multisystem organ failure despite successful repair. These temporal distinctions should guide future mechanistic and intervention evaluations to improve RAAA mortality.
我们旨在比较破裂性腹主动脉瘤（RAAA）修复术后的即刻和早期死亡率。对 RAAA 的评估侧重于术后 30 天的死亡率。其他紧急情况，如创伤，已经证明在 30 天窗口内存在多模态死亡率分布，这扩展了病理生理学的理解，并允许进行干预研究，从而带来改变实践和拯救生命的结果。然而，RAAA 术后发病率和死亡率的时间分布和危险因素尚未得到研究。
我们使用血管质量倡议（2010-2020 年）的数据，在一项具有里程碑意义的回顾性队列研究中，评估了与 RAAA 术后即刻（<1 天）和早期（1-30 天）期间死亡率相关的因素。
我们确定了 5157 例 RAAA 修复术（平均年龄 72±10 岁；77%为男性；88%为白人；61%为血管内）。即刻死亡率为 10.2%（528/5157），早期死亡率为 22.1%（918/4163）。多变量回归分析显示，出血性休克的迹象（即血红蛋白<7g/dL：调整后的优势比[aOR]，1.87[95%置信区间[CI]，1.14-3.06]；任何术前收缩压<70mmHg：aOR，1.40[95%CI，1.04-1.89]；和估计失血量>40%：aOR，3.65[95%CI，2.29-5.83]）与即刻死亡率增加相关。合并症（心力衰竭：aOR，1.38[95%CI，1.00-1.92]；肺部疾病：aOR，1.29[95%CI，1.05-1.58]；肌酐升高：aOR 1.26[95%CI，1.31-1.41]）与早期死亡率增加相关。
即刻死亡主要与大出血引起的休克有关，而早期死亡与合并症有关，尽管修复成功，但这些合并症使患者易发生多器官系统衰竭。这些时间上的区别应该指导未来的机制和干预评估，以提高 RAAA 的死亡率。
