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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 1999 June;40(3):401-5

language: English

Ruptured abdom­i­nal aor­tic aneu­rysms: Anal­y­sis of fac­tors influ­enc­ing sur­gi­cal ­results in 184 ­patients

Sasaki S., Sakuma M., Samejima M., Kunihara T., Shiiya N., Murashita T., Matsui Y., Yasuda K.

From the Department of Cardiovascular Surgery, Hokkaido University Hospital, Kita-ku, Sapporo, Japan


Background. Rupture is ­often the ­first man­i­fes­ta­tion in ­patients ­with abdom­i­nal aor­tic aneu­rysms. Although elec­tive sur­gery for non-rup­tured abdom­i­nal aor­tic aneu­rysms has pro­vid­ed sat­is­fac­to­ry sur­gi­cal ­results, oper­a­tive mor­tal­ity of rup­tured abdom­i­nal aor­tic aneu­rysms (rAAA) has not ­improved. The pur­pose of ­this ­study was to iden­ti­fy pre­dic­tors for ear­ly hos­pi­tal ­death in ­patients ­with rAAA.
Methods. Design: A ret­ro­spec­tive ­study. Setting: A uni­ver­sity hos­pi­tal and 20 affil­i­at­ed hos­pi­tals. Patients: Patients under­go­ing sur­gi­cal treat­ment for rAAA (n=183) ­between 1968 and 1997. Interventions: All ­patients ­were sur­gi­cal­ly treat­ed and divid­ed ­into oper­a­tive sur­vi­vors (n=119) and non-sur­vi­vors (n=64). Measures: The ­patient-relat­ed, pro­ce­dure-relat­ed, and post­op­er­a­tive fac­tors ­were com­pared ­between the two ­groups. A mul­ti­var­i­ate anal­y­sis was ­also con­duct­ed to deter­mine pre­dic­tors for hos­pi­tal ­deaths.
Results. In uni­var­i­ate anal­y­sis, age at oper­a­tion (p=0.004), pre­op­er­a­tive hemo­dy­nam­ic con­di­tions (p<0.0001), ­extent of hemat­o­ma (p<0.0001), pre­ex­is­tent ­renal dys­func­tion (p=0.001), and vol­umes of ­blood ­loss at oper­a­tion (p=0.001) ­were sig­nif­i­cant­ly dif­fer­ent ­between the two ­groups. The mor­bid­ity of post­op­er­a­tive ­renal fail­ure (p<0.0001), gut ische­mia (p=0.003), ­heart fail­ure or ischem­ic ­heart dis­ease (p<0.0001), and mul­ti­ple ­organ dys­func­tion syn­drome (p<0.0001) was high­er in the non-­survivors’ ­group. Multivariate anal­y­sis ­also iden­ti­fied pre­op­er­a­tive hemo­dy­nam­ic con­di­tions, ­blood ­loss vol­ume at oper­a­tion, pre­ex­is­tent ­renal dys­func­tion, post­op­er­a­tive ­renal fail­ure, ­heart fail­ure, and mul­ti­ple ­organ dys­func­tion syn­drome as incre­men­tal ­risk fac­tors for hos­pi­tal ­deaths.
Conclusions. Every ­effort to main­tain pre­op­er­a­tive hemo­dy­nam­ic con­di­tions, to ­reduce vol­umes of ­blood ­loss at oper­a­tion, and to min­i­mize dete­ri­ora­tion of ­organ func­tions post­op­er­a­tive­ly is all essen­tial to ­improve ­patient sur­vi­val.

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