Ruptured abdominal aortic aneurysms: Factors influencing postoperative mortality and long-term survival

Objective:To update mortality rates and long-term survival of patients admitted to the hospital with ruptured abdominal aortic aneurysm (AAA) and to study prognostic factors associated with mortality.Design:Retrospective follow-up.Materials:309 patients (274 men, 35 women, average age 71) admitted to the hospital between January 1980 and January 1994 who were surgically treated for ruptured AAA were studied.Methods:To identify the preoperative (9), intraoperative (23) and postoperative (49) variables associated with mortality logistic regression analysis (mortality within 48 h) and Cox regression analysis (mortality between 48 h and 30 days) were performed.Results:Hospital mortality improved from 1980 to 1994. Compared with the normal population adjusted for age and sex the long-term mortality rate was increased (standardised mortality ratio 2.1; 95% confidence interval 1.7–2.5). Increased age, peroperative hypotension and need for a bifurcated graft were associated with significantly increased mortality. Co-morbidity was not a predictive variable. Overall hospital mortality was 25%.Conclusion:Surgical repair of ruptured AAA should be considered even in patients with co-morbidity. Elderly patients with severe preoperative hypotension have a very high mortality rate and surgery may not be justified in these cases. Long-term survival is also worse in older patients