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• W4246200711 abstract "Various risk score calculators predicting 30-day mortality after treatment of ruptured abdominal aortic aneurysms (rAAAs) have produced mixed results regarding their usefulness and reproducibility. We sought to prospectively validate the accuracy of our preoperative scoring system in a modern cohort of patients with rAAAs. A retrospective review of all patients with rAAAs who had presented to a single academic center from January 2002 to December 2018 was performed. The patients were divided into 3 cohorts according to when the institutional practice changes occurred: pre-endovascular (rAAAs undergoing endovascular aneurysm repair [rEVAR]) era (January 2002 to July 2007), the pre–risk score use era (August 2007 to October 2013), and the modern era (November 2013 to December 2018). The primary outcome measure was 30-day mortality. Our preoperative risk score assigns 1 point for each of the following: age >76 years, pH <7.2, creatinine >2 mg/dL, and hypotension (systolic blood pressure <70 mm Hg). Previously reported mortality based on retrospective analysis of the first 2 cohorts was 22% for 1 point, 69% for 2 points, 78% for 3 points, and 100% for 4 points. The goal of our study was to prospectively validate our scoring system in the third cohort. During the 17-year study period, 417 patients with rAAAs had been treated at our institution. Of the 118 patients treated in the modern era, 45 (38.1%) had undergone open repair (rOAR), 61 (51.7%) had undergone rEVAR, and 12 (10.2%) had been treated with comfort measures only. Excluding the 12 patients without repair (Table), we found a statistically significant linear trend between the preoperative risk score and subsequent 30-day mortality for all patients combined (P < .0001), rOAR patients alone (P =.0003), and rEVAR patients alone (P < .0001). After adjustment for the preoperative risk score, the 30-day mortality was 41.3% versus 31.6% after rOAR versus rEVAR, respectively (P = .2). For all repairs, 30-day mortality was 14.6% for a score of 0, 35.7% for 1, 68.4% for 2, and 100% for a score of 3 or 4. Our results, representing one of the largest modern series of rAAAs treated at a single institution, have confirmed the accuracy of a simple 4-point preoperative risk score in predicting 30-day mortality in modern patients with rAAAs. Such tools should be used when discussing treatment options with patients and family members to help guide transfer and treatment decision making. TableThirty-day mortality by repair type and risk scoreRisk scoreCombined mortalityrOAR mortalityrEVAR mortality06/41 (14.6)2/17 (11.8)4/24 (16.7)115/42 (35.7)11/20 (55.0)4/22 (18.2)213/19 (68.4)4/7 (57.1)9/12 (75.0)33/3 (100)1/1 (100)2/2 (100)41/1 (100)0/0 (0)1/1 (100)P value (trend)<.0001.0003<.0001rEVAR, Ruptured abdominal aortic aneurysms undergoing endovascular aneurysm repair; rOAR, ruptured abdominal aortic aneurysms undergoing open repair.Data presented as number/total number (%). Open table in a new tab" @default.
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• W4246200711 date "2020-09-01" @default.
• W4246200711 modified "2023-10-16" @default.
• W4246200711 title "Preoperative Risk Score Accuracy Is Confirmed in a Modern Ruptured Abdominal Aortic Aneurysm Experience" @default.
• W4246200711 doi "https://doi.org/10.1016/j.jvs.2020.07.002" @default.
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