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A Review of Intraoperative and Preoperative Parameters That Predict Death and other Negative Outcomes after Repair of Ruptured Abdominal Aortic Aneurysm

OBJECTIVES: We were interested in analyzing patients that received large volumes of fluid and required delayed closure of their abdomen. We report our experience with 82 patients with rAAA.

METHODS: Retrospective chart review from 1997-2006 of patients with infrarenal rAAA who survived to the recovery room. Predictive parameters: duration of time that SBP was <90mmHg, units of PRBCs, fluids and primary or delayed closure of the abdomen. Outcome measures: mortality, organ failure, reoperative procedures, length of stay and abdominal compartment syndrome.

RESULTS: Mortality rate was 46% for subject who made it though surgery. T-tests were significant when comparing total volume (p = 0.03) or the volume of PRBCs (p = 0.001) transfused with mortality. Using logistical regression PRBCs proved to be a significant predictor of length of stay (p=0.01). PRBCs was also a significant predictor of mortality and composite negative outcomes in both logistical regression (p= 0.009/0.0001) and ROC analyses (AUC = 0.814); a cut-point point of 8 units was identified. Logistical regression was not significant for length of hypotension predicting any negative outcome. Both total volume and units of PRBCs only approached significance when predicting delayed closure (p = 0.08 and p = 0.06). Chi Square indicated no significant relationship between delayed vs. primary closure and the composite negative outcome.

CONCLUSIONS: Giving less fluid and allowing some degree of hypotension did not predict any negative outcomes. Patients who received aggressive fluid resuscitation did not experience higher rates of mortality or graft infections as a result of being managed with an open abdomen. Patients who received 8 or more units of PRBCs in the OR had the strongest significant predictor of increased morbidity and mortality.