Ruptured abdominal aortic aneurysm: Influence of intraoperative management on surgical outcome

AbstractPurpose: This study was designed to determine the influence of changes in intraoperative management on the outcome of ruptured abdominal aortic aneurysm (RAAA).Methods: Retrospective review of our surgical experience of RAAA identified 61 patients and was separated into two periods: 1986 to 1988 (group 1 [n = 21 patients]) and 1989 to 1994 (group 2 [n = 40 patients]). Since 1989 operations have been conducted by two vascular surgeons without systemic administration of heparin and with control of suprarenal aorta if extensive hematoma is present, use of collagen-impregnated grafts, preferential repair with aortoaortic grafting, and routine use of intraoperative autotransfusion.Results: Factors differing between the groups were use of intraoperative autotransfusion (4.76% in group 1 vs 80% in group 2, p < 0.00001), repair with tube grafting (42.8% in group 1 vs 80% in group 2, p = 0.003), number of packed homologous red blood cells (7.5 ± 5.2 units in group 1 vs 3.1 ± 3.6 units in group 2, p = 0.008), postoperative blood loss (365 ± 705 ml in group 1 vs 133 ± 351 ml in group 2, p = 0.01). The intraoperative mortality rate was significantly lower in group 2 (5% vs 28.6%, p = 0.016). The only predictive factor was the use of intraoperative autotransfusion with a lower mortality rate in patients undergoing autotransfusion (p = 0.029). The postoperative mortality rate was significantly lower in group 2 (20% vs 52.4%, p = 0.009). Predictive factors were use of intraoperative autotransfusion (p = 0.0009), age of the patients (p = 0.0039), and repair with tube graft (p = 0.039). The odds ratio of postoperative death was 25 times higher without intraoperative autotransfusion and seven times lower when a tube graft was used.Conclusion: Continuing efforts to achieve improvement in surgical technique and use of intraoperative autotransfusion were important determinants in lowering the postoperative mortality rate of RAAA to 20%. (J VASC SURG 1995;22:780-6.