Troisi Nicola, Bertagna Giulia, Saratzis Athanasios, Guadagni Simone, Minichilli Fabrizio, Adami Daniele, Ferrari Mauro, Berchiolli Raffaella
Unit of Vascular Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, Cisanello Hospital, University of Pisa, Pisa, Italy -
Unit of Vascular Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, Cisanello Hospital, University of Pisa, Pisa, Italy.
Int Angiol. 2023 Aug;42(4):310-317. doi: 10.23736/S0392-9590.23.04941-6. Epub 2023 Jun 28.
Several models and scores have been released to predict early mortality in patients undergoing surgery for a ruptured abdominal aortic aneurysm (rAAA). These scores included above all preoperative factors and they could be useful to deny surgical repair. The aim of the study was to evaluate intraoperative predictors of in-hospital mortality in patients undergoing open surgical repair (OSR) for a rAAA.
Between January 2007 and December 2020, 265 patients were admitted at our tertiary referral hospital for a rAAA. Two-hundred-twenty-two patients underwent OSR. Intra-operative factors were analyzed by means of univariate analysis (step 1). Associations of procedure variables with in-hospital mortality rates were sought based on a multivariate Cox regression analysis (step 2).
Overall, in-hospital mortality rate was 28.8% (64 cases). Multivariate Cox regression analysis reported that operation time >240 minutes (P=0.032, OR 2.155, CI 95% 1.068-4.349), and hemoperitoneum (P<0.001, OR 3.582, CI 95% 1.749-7.335) were negative predictive factors for in-hospital mortality. Patency of at least one hypogastric artery (P=0.010; OR 0.128, CI 95% 0.271-0.609), and infrarenal clamping (P=0.001; OR 0.157, CI 95% 0.052-0.483) had a protective role in reducing in-hospital mortality rate.
Operation time >240 minutes, and hemoperitoneum affected in-hospital mortality in patients undergoing OSR for rAAA. Patency of at least one hypogastric artery, and infrarenal clamping had a protective role. Further studies are needed to validate these outcomes. A validated predictive model could be useful to help the physicians in communication with patients' relatives.
已经发布了几种模型和评分系统来预测腹主动脉瘤破裂（rAAA）患者手术早期死亡率。这些评分主要包括术前因素，它们有助于拒绝手术修复。本研究的目的是评估接受腹主动脉瘤破裂开放手术修复（OSR）患者的院内死亡术中预测因素。
2007年1月至2020年12月期间，265例腹主动脉瘤破裂患者入住我们的三级转诊医院。222例患者接受了开放手术修复。通过单因素分析（步骤1）分析术中因素。基于多因素Cox回归分析（步骤2）寻找手术变量与院内死亡率之间的关联。
总体而言，院内死亡率为28.8%（64例）。多因素Cox回归分析表明，手术时间>240分钟（P=0.032，OR 2.155，95%CI 1.068-4.349）和腹腔积血（P<0.001，OR 3.582，95%CI 1.749-7.335）是院内死亡的负性预测因素。至少一条下腹动脉通畅（P=0.010；OR 0.128，95%CI 0.271-0.609）和肾下阻断（P=0.001；OR 0.157，95%CI 0.052-0.483）对降低院内死亡率具有保护作用。
手术时间>240分钟和腹腔积血影响腹主动脉瘤破裂接受开放手术修复患者的院内死亡率。至少一条下腹动脉通畅和肾下阻断具有保护作用。需要进一步研究来验证这些结果。经过验证的预测模型可能有助于医生与患者家属沟通。
