Free Rupture Is The Strongest Predictor For Mortality In Ruptured Abdominal Aortic Aneurysm
Bo Wang, MD, Amit Rao, MD, Sonia Talathi, MD, Gregg Landis, MD, Yana Etkin, MD.
Northwell Health NSLIJ, New York, NY, USA.
Free Rupture is the Strongest Predictor for Mortality in Ruptured Abdominal Aortic Aneurysm
OBJECTIVE:
In this study, we review our institutional experience with ruptured abdominal aortic aneurysms (rAAA) repair and investigate the Harbor View Medical Center (HVM) preoperative risk score as a tool to predict mortality.
Method:
A retrospective review of patients who presented with rAAA to a single tertiary academic medical center between 2014 and 2019 was performed. Perioperative co-morbidities were analyzed using univariate and multivariate logistic regression to determine their association with 30-day mortality. Lamda correlation coefficient was used to determine their strength of correlation with mortality.
Result:
52 patients presented with rAAA and 46 underwent surgical repair. The cohort has an average age of 77.7±12.3 years and 69.3% of patients were male. Out of the patients who underwent repair, 43.5% had free rupture. 84.8% patients underwent EVAR and 15.2% had open repair, which resulted in a total mortality of 43.5%. Free rupture carried a mortality of 75% as compared to 25% in contained rupture group and it was the strongest predictor for mortality (OR=15.0, p=0.000). Open repair had significantly higher mortality than EVAR (85.7% vs. 35.9%, p= 0.033). Combination of free rupture with open repair was associated with 100% mortality (n=4).
Lamda correlation coefficient showed free rupture has strong correlation with mortality (0.500, p= 0.011), while pH <7.2 and BP< 70 showed weak but significant correlation (0.222, p= 0.026 for both). Both of these factors also had significant correlation with free rupture (0.276, p=0.002).
In analyzing HVM risk score, all patients with 3 and 4 points had died. 2 points carried a mortality of 60.0%, 1 point was 41.2% and 0 point was 7.7% (p=0.001). On multivariate regression analysis, only pH and BP were determined to be independent predictors for mortality. Creatinine >2 mg/dL (p=0.080) and age (p=0.459) were not.
Conclusion:
Our cohort confirmed that HVM risk score could accurately predict risk of mortality in rAAA patients; however, advanced age and increased creatinine did not show significance in our regression and correlation analysis. Free rupture was the strongest predictor for mortality. Based on our experience, one may consider withholding intervention in patients with free rAAA who has low pH and BP on presentation, especially if endovascular intervention is not available.
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