Ruptured abdominal aortic aneurysms. A community experience
S. G. Katz and R. D. Kohl
Department of Surgery, Huntington Memorial Hospital, Pasadena, CA.
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.
