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March 1994

Ruptured Abdominal Aortic Aneurysms: A Community Experience

Author Affiliations

From the Department of Surgery, Huntington Memorial Hospital, Pasadena, Calif.

Arch Surg. 1994;129(3):285-290. doi:10.1001/archsurg.1994.01420270061014

Objective:  To determine the relative contribution of preoperative, operative, and postoperative factors to mortality in patients with ruptured abdominal aortic aneurysms.

Design:  Retrospective case series.

Setting:  Three primary care hospitals in a community setting.

Patients:  Ninety-nine patients operated on for ruptured abdominal aortic aneurysms in the selected community between January 1984 and January 1992.

Outcome Measures:  Preoperative, operative, and postoperative factors were subjected to univariate and multivariate analysis to determine their relative contribution to patient mortality. Differences were considered significant at P=.05.

Results:  The overall in-hospital mortality rate was 57%. The independent predictors of death were patient's age, surgical expertise, major intraoperative technical problems, hematocrit on admission, and units of red blood cells transfused during surgery (P<.05 for each). The operative mortality rate for individual surgeons ranged from 20% to 100%. Fifteen technical errors were identified, resulting in a 43% mortality rate. Surgeons with the highest mortality rates had the highest incidence of iatrogenic technical problems (P>.001).

Conclusions:  The outcome of patients with ruptured abdominal aortic aneurysms is, in part, determined by their preoperative status; however, surgical expertise and the avoidance of technical error significantly impact survival in patients with ruptured abdominal aortic aneurysms and should be a major focus of our attention.(Arch Surg. 1994;129:285-290)