Ruptured Abdominal Aortic Aneurysms in Community Practice: Age and Operative Variables Predict Survival

Abstract

Our objective is to determine if the mortality and functional outcome of patients with ruptured abdominal aortic aneurysms treated at community hospitals is more a function of patient factors and comorbidities or hospital system and surgeon-controlled variables. We used a retrospective review of all patients with infrarenal ruptured abdominal aortic aneurysms treated at three large community hospitals in Chicago from 1996 to 2005. There was an overall 58 per cent mortality rate. There was a statistically significant difference in the age of those who lived (69 ± 9.8) and those who died (78 ± 7.9, P = 0.0005). Mortality was found to increase with each increasing decade of life. None of the patients from age 50 to 60 died, whereas 44 per cent of the patients from 61 to 70, 65 per cent of those 71 to 80, 64 per cent of those 81 to 90, and 100 per cent of those older than 90 died. There was an increased hazard ratio of 10.9 times the risk of mortality once a patient became older than age 70 (P = 0.02). Intra-operative variables did influence survival: duration of surgery (lived 230 ± 78 minutes, died 324 ± 130 minutes, P = 0.006), intra-operative blood loss (lived 1894 ± 1014 mL, died 5692 ± 3018 mL, P = 0.00003), and blood transfusion (lived 6.7 ± 2.8 units, died 10.5 ± 3.7 units, P = 0.0006). Age and intra-operative factors play a major role in the survival or mortality of patients with ruptured abdominal aortic aneurysms. Short operative time combined with minimizing blood loss and transfusion requirements improve survival, especially in the elderly.