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Prognostic factors associated with mortality in patients undergoing emergency surgery for abdominal aortic aneurysms

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Abstract

Purpose

Surgical mortality rates following emergency surgery for ruptured abdominal aortic aneurysms (AAAs) remain high. This study investigated the mortality rate and identified prognostic factors affecting mortality in patients undergoing emergency repair of AAAs in our hospital.

Methods

Between January 2005 and June 2010, a total of 42 patients underwent emergency surgery for AAAs and were included in this retrospective study. The following variables concerning each patient were collected by chart review and compared between survivors and nonsurvivors: age; gender; preoperative levels of hemoglobin (Hb), hematocrit (Ht), platelets (Plts), base excess (BE), and serum glucose and lactate; presence of preoperative shock defined as hypotension (systolic blood pressure of less than 80 mmHg); incidence of blood transfusion, whether AAA was ruptured or impending; interval from admission to the hospital or arrival in the operating room until aortic cross-clamping; surgical duration; and volume of intraoperative blood loss and transfusion, total fluid infusion, and urine output.

Results

Nine patients died within 30 days postoperatively, a 30-day mortality rate of 21.4%. Among these nine nonsurvivors, eight had shown persistent preoperative shock (P = 0.0004 vs. survivors). Compared with the survivors, nonsurvivors were significantly older (P = 0.0052) and had lower preoperative levels of Hb/Ht (P < 0.0001), Plts (P = 0.0003), and BE (P < 0.0001), an elevated lactate level (P = 0.0048), shorter interval from admission (P = 0.0459) or arrival in the operating room (P = 0.0288) until aortic clamping, and intraoperatively more hemorrhage (P = 0.0038) associated with larger amounts of blood transfusion (P = 0.0083) and less urine output (P = 0.0004).

Conclusions

The authors clarified that certain features such as age, persistent preoperative shock, and greater amounts of transfusion associated with greater blood loss and anemia were factors affecting the mortality in patients undergoing emergency surgery for AAAs. It might be of great importance to correct preoperative shock and anemia caused by massive bleeding before the onset of hemodynamic deterioration.

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References

  1. Johansen K, Kohler TR, Nicholis SC, Zierier RE, Clowess AW, Kazmers A. Ruptured abdominal aortic aneurysm: the Harborview experience. J Vasc Surg. 1991;13:240–7.

    Article  PubMed  CAS  Google Scholar 

  2. Harris LM, Faggioli GL, Fiedler R, Curl GR, Ricotta JJ. Ruptured abdominal aortic aneurysms: factors affecting mortality rates. J Vasc Surg. 1991;14:812–20.

    Article  PubMed  CAS  Google Scholar 

  3. Chen JC, Hildebrand HD, Salvian AI, Taylor DC, Strandberg S, Myckatyn TM, Hsiang YN. Predictors of death in nonruptured and ruptured abdominal aortic aneurysms. J Vasc Surg. 1996;24:614–23.

    Article  PubMed  CAS  Google Scholar 

  4. Halpern VJ, Kline RG, D’Angelo AJ, Cohen JR. Factors that affect the survival rate of patients with ruptured abdominal aortic aneurysms. J Vasc Surg. 1997;26:939–48.

    Article  PubMed  CAS  Google Scholar 

  5. Sasaki S, Sakuma M, Samejima M, Kunihara T, Shiiya N, Murashita T, Matsui Y, Yasuda K. Ruptured abdominal aortic aneurysms: analysis of factors influencing surgical results in 184 patients. J Cardiovasc Surg. 1999;40:401–5.

    CAS  Google Scholar 

  6. Noel AA, Gloviczki P, Cherry KJ, Bower TC, Panneton JM, Mozes GI, Harmsen WS, Jenkins GD, Hallett JW Jr. Ruptured abdominal aortic aneurysms: the excessive mortality rate of conventional repair. J Vasc Surg. 2001;34:41–6.

    Article  PubMed  CAS  Google Scholar 

  7. Alonso-Pérez M, Segura RJ, Sánchez J, Sicard G, Barreiro A, García M, Díaz P, Barral X, Cairols MA, Hernández E, Moreira A, Bonamigo TP, Llagostera S, Matas M, Allegue N, Krämer AH, Mertens R. Factors increasing the mortality rate for patients with ruptured abdominal aortic aneurysms. Ann Vasc Surg. 2001;15:601–7.

    Article  PubMed  Google Scholar 

  8. Kniemeyer HW, Reber PU, Kessler T, Beckmann H, Hakki H. Risk assessment in patients with ruptured abdominal aortic aneurysms. Acta Chir Belg. 2002;102:176–82.

    PubMed  CAS  Google Scholar 

  9. Piper G, Patel NA, Chandela S, Benckart DH, Young JC, Collela JJ, Healy DA. Short-term predictors and long-term outcome after ruptured abdominal aortic aneurysm repair. Am Surg. 2003;69:703–9.

    PubMed  Google Scholar 

  10. Grant MW, Thomson IA, van Rij AM. In-hospital mortality of ruptured abdominal aortic aneurysm. A N Z J Surg. 2008;78:698–704.

    Article  Google Scholar 

  11. Bauer EP, Redaelli C, von Segesser LK, Turina MI. Ruptured abdominal aortic aneurysms: predictors for early complications and death. Surgery (St. Louis). 1993;114:31–5.

    CAS  Google Scholar 

  12. Meesters RCT, van der Graaf Y, Vos A, Eikelboom BC. Ruptured aortic aneurysm: early postoperative prediction of mortality using an organ system failure score. Br J Surg. 1994;81:512–6.

    Article  PubMed  CAS  Google Scholar 

  13. Farooq MM, Freischlag JA, Seabrook GR, Moon MR, Aprahamian C, Towne JB. Effect of the duration of symptoms, transport time, and length of emergency room stay on morbidity and mortality in patients with ruptured abdominal aortic aneurysms. Surgery (St. Louis). 1996;119:9–14.

    Article  CAS  Google Scholar 

  14. Lazarides MK, Arvanitis DP, Drista H, Staramos DN, Dayantas JN. POSSUM and APACHE II scores do not predict the outcome of ruptured infrarenal aortic aneurysms. Ann Vasc Surg. 1997;11:155–8.

    Article  PubMed  CAS  Google Scholar 

  15. Maziak DE, Lindsay TF, Marshall JC, Walker PM. The impact of multiple organ dysfunction on mortality following ruptured abdominal aortic aneurysm repair. Ann Vasc Surg. 1998;12:93–100.

    Article  PubMed  CAS  Google Scholar 

  16. Norman PE, Semmens JB, Lawrence-Brown MMD, Holman CDJ. Long term relative survival after surgery for abdominal aortic aneurysm in Western Australia: population-based study. BMJ. 1998;317:852–6.

    PubMed  CAS  Google Scholar 

  17. Kniemeyer HW, Kessler T, Reber PU, Ris HB, Hakki H, Widmer MK. Treatment of ruptured abdominal aortic aneurysm, a permanent challenge or a waste of resources? Prediction of outcome using a multi-organ-dysfunction score. Eur J Endovasc Surg. 2000;19:190–6.

    Article  CAS  Google Scholar 

  18. Dueck AD, Kucey DS, Johnston KW, Alter D, Laupacis A. Survival after ruptured abdominal aortic aneurysm: effect of patient, surgeon, and hospital factors. J Vasc Surg. 2004;39:1253–60.

    Article  PubMed  Google Scholar 

  19. Alexander S, Bosch JL, Hendrinks JM, Visser JJ, van Sambeek MRHM. The 30-day mortality of ruptured abdominal aortic aneurysms: influence of gender, age, diameter and comorbidities. J Cardiovasc Surg. 2008;49:633–7.

    CAS  Google Scholar 

  20. Giordano S, Biancari F, Loponen P, Wistbacka J-O, Luther M. Preoperative haemodynamic parameters and the immediate outcome after open repair of ruptured abdominal aortic aneurysms. Interact Cardiovasc Thorac Surg. 2009;9:491–3.

    Article  PubMed  Google Scholar 

  21. Koga Y, Hara M, Mori S, Miyawaki N, Mishima Y, Kano T, Ushijima K. Factors that affect the mortality in patients receiving emergency surgery for ruptured abdominal aortic aneurysms. Masui (Jpn J Anesthesiol). 2011;60:195–8. (in Japanese with English abstract).

    Google Scholar 

  22. Rutherford RB. Classification of ruptured aortic aneurysms aids comparison of results. Vasc Surg Outlook. 1992;4:1–2.

    Google Scholar 

  23. Johansson G, Swedenborg J. Ruptured abdominal aortic aneurysms: a study of incidence and mortality. Br J Surg. 1986;73:101–3.

    Article  PubMed  CAS  Google Scholar 

  24. Budd JS, Finch DR, Carter PG. A study of the mortality from ruptured abdominal aortic aneurysms in a district community. Eur J Vasc Surg. 1989;3:351–4.

    Article  PubMed  CAS  Google Scholar 

  25. Gaughan M, McIntosh D, Brown A, Laws D. Emergency abdominal aortic aneurysm presenting without haemodynamic shock is associated with misdiagnosis and delay in appropriate clinical management. Emerg Med J. 2009;26:334–9.

    Article  PubMed  CAS  Google Scholar 

  26. Singhal R, Coghill JE, Guy A, Bradbury AW, Adam DJ, Scriven JM. Serum lactate and base deficit as predictors of mortality after ruptured abdominal aortic aneurysm repair. Eur J Vasc Surg. 2005;30:263–6.

    Article  CAS  Google Scholar 

  27. Glance LG, Dick AW, Mukamel DB, Fleming FJ, Zollo RA, Wissler R, Salloum R, Meredith UW, Osler TM. Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology. 2011;114:283–92.

    Article  PubMed  Google Scholar 

  28. Ganeshanantham G, Walsh SR, Varty K. Abdominal compartment syndrome in vascular surgery: a review. Int J Surg. 2010;8:181–5.

    Article  PubMed  CAS  Google Scholar 

  29. Makar RR, Badger SA, O’Donnell ME, Loan W, Lau LL, Soong CV. The effects of abdominal compartment hypertension after open and endovascular repair of a ruptured abdominal aortic aneurysm. J Vasc Surg. 2009;49:866–72.

    Article  PubMed  Google Scholar 

  30. Lovegrove RE, Javid M, Magee TR, Galland RB. A meta-analysis of 21178 patients undergoing open or endovascular repair of abdominal aortic aneurysm. Br J Surg. 2008;95:677–84.

    Article  PubMed  CAS  Google Scholar 

  31. Veith FJ, Lachat M, Mayer D, Malina M, Holst J, Mehta M, Verhoeven ELG, Larzon T, Gennai S, Coppi G, Lipsitz EC, Gargiulo NJ, van der Vliet A, Blankensteijn J, Buth J, Lee A, Biasi G, Deleo G, Kasirajan K, Moore R, Soong CV, Cayne NS, Farber MA, Raithel D, Greenberg RK, van Sambeek MRHM, Brunkwall JS, Rockman CB, Hinchliffe RJ. Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms. Ann Surg. 2009;250:818–24.

    Article  PubMed  Google Scholar 

  32. Foster J, Ghosh J, Baguneid M. In patients with ruptured abdominal aortic aneurysm does endovascular repair improve 30-day mortality? Interact Cardiovasc Thorac Surg. 2010;10:611–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan

    Yukari Koga, Yasunori Mishima, Masato Hara, Teruyuki Hiraki & Kazuo Ushijima

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  1. Yukari Koga
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  2. Yasunori Mishima
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  3. Masato Hara
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  4. Teruyuki Hiraki
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  5. Kazuo Ushijima
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Correspondence to Yukari Koga.

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Koga, Y., Mishima, Y., Hara, M. et al. Prognostic factors associated with mortality in patients undergoing emergency surgery for abdominal aortic aneurysms. J Anesth 25, 666–671 (2011). https://doi.org/10.1007/s00540-011-1185-5

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  • DOI: https://doi.org/10.1007/s00540-011-1185-5

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