ICU Admission APACHE III Score Predicts Hospital Mortality in Thoracoabdominal Aneurysms (TAAA) repair and Abdominal Aortic Aneurysms (AAA) repair

OBJECTIVES:
Mortality prediction models are used for risk adjustment and to assess clinical outcome. The most extensively studied model being the Acute Physiology and Chronic Health Evaluation (APACHE) system. The objective of this study was to evaluate APACHE III ICU admission scores in the prediction of hospital mortality in patients undergoing elective TAAA and AAA aneurysm repairs.
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METHODS:
Prospective data (demographics, admitting diagnosis, APACHE III score, ICU and hospital length of stay (LOS), and mortality) were collected by a dedicated APACHE III coordinator for all patients admitted to a tertiary academic surgical ICU (20 beds) over a 9 year period (7/1998 through 6/2007). Observational and comparative analyses were performed. Ruptured aneurysms were excluded.

RESULTS:
Open elective repair was preformed on 41 TAAA patients and 403 AAA patients. Mean age was 70.3 ± 8.3 years for TAAA vs 63.4 ± 9.8 for the AAA group. In the TAAA group mean ICU length of stay was longer (12.4 ± 3.9 days vs. 3.9 ± 0.3 days, P<.001), mean hospital length of stay was longer (23.1 ± 3.9 days vs. 10.7 ± 0.5 days, P<.001), mean ICU admission APACHE III score was higher 47 (40 - 65) vs 43 (34 - 54) (P =0.008), in-hospital mortality rates was higher 4.9% (2 patients) vs 2.0% (8 patients) (P= 0.236).
Table 1 documents that the APACHE III score predicts mortality in patients undergoing elective TAAA and AAA repair.

CONCLUSIONS:
The initial Apache III score at ICU admission is an excellent predictor of hospital survival in patients undergoing elective AAA or TAAA repair. APACHE III provides accurate risk stratification and mortality prediction in this vascular surgery patient population