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Predictors affecting in-hospital mortality of ruptured abdominal aortic aneurysms: a Greek multicenter study.
Ann Vasc Surg. 2014 Aug; 28(6):1384-90.AV

Abstract

BACKGROUND

Endovascular aortic repair (EVAR) is being used with increasing frequency for the treatment of ruptured abdominal aortic aneurysms (rAAAs), although conflicting results have been reported concerning perioperative mortality. The aim of our study was to evaluate potential difference in mortality rates between EVAR and open surgical repair (OSR) and identify independent risk factors for in-hospital mortality in rAAAs. This study also aimed to evaluate the Glasgow Aneurysm Score (GAS) in predicting in-hospital mortality. A time-trend analysis of EVAR for ruptured AAAs was also performed.

METHODS

Prospectively collected data from 7 public hospitals in Greece concerning rAAA repairs between January 2006 and April 2012 were analyzed. Primary outcome was in-hospital mortality. Multivariate logistic regression analysis was used to identify independent risk factors. The receiver-operator characteristic curve was used to determine the value of the GAS in predicting in-hospital death. Time-trend analysis, depicting annual changes (%), concerning EVAR for ruptured AAAs was also conducted.

RESULTS

A total of 418 patients (92.3% men, mean age = 74.3 ± 8.8) with rAAAs were recorded during the study period. Among them, 113 patients (27%) underwent EVAR. Overall in-hospital mortality was 45.2%, whereas in-hospital mortality after EVAR and OSR was 20.4% and 54.3%, respectively (P < 0.001). Multivariate analysis evidenced that hemodynamic instability (P < 0.001), OSR (P < 0.001), age ≥80 years (P < 0.001), coronary artery disease (P < 0.001), and renal insufficiency (P = 0.02) independently increased in-hospital mortality. Area under the curve of GAS was 0.80 (95% confidence interval [CI] = 0.75-0.85, P < 0.001) for OSR and 0.64 (95% CI = 0.51-0.77, P = 0.04) for EVAR. Annual increase of proportion (%) of EVAR for rupture was 5% (P = 0.004).

CONCLUSIONS

EVAR is being used with increasing frequency for the treatment of rAAAs and it appears to be associated with lower in-hospital mortality compared with OSR, after adjustment for hemodynamic instability and known atherosclerotic risk factors. Preoperative predictors of in-hospital mortality such as GAS should be probably modified in these patients.

Authors+Show Affiliations

Department of Vascular Surgery, University General Hospital "Attikon", Athens, Greece. Electronic address: kostas.antonopoulos@gmail.com.Department of Vascular Surgery, University General Hospital "Attikon", Athens, Greece.General Hospital "Korgialenio - Benakio National Red Cross", Athens, Greece.General Hospital "Konstantopoulio - Agia Olga", Athens, Greece.General Hospital "Laikon", Athens, Greece.University Hospital of Larissa, Larissa, Greece.General Hospital of Thessaloniki "Papageorgiou", Thessaloniki, Greece.3rd Surgical Department, University General Hospital "Attikon", Athens, Greece.General Hospital "Sismanoglio", Athens, Greece.Department of Vascular Surgery, University General Hospital "Attikon", Athens, Greece.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

24517989

Citation

Antonopoulos, Constantine N., et al. "Predictors Affecting In-hospital Mortality of Ruptured Abdominal Aortic Aneurysms: a Greek Multicenter Study." Annals of Vascular Surgery, vol. 28, no. 6, 2014, pp. 1384-90.
Antonopoulos CN, Kakisis JD, Andrikopoulos V, et al. Predictors affecting in-hospital mortality of ruptured abdominal aortic aneurysms: a Greek multicenter study. Ann Vasc Surg. 2014;28(6):1384-90.
Antonopoulos, C. N., Kakisis, J. D., Andrikopoulos, V., Dervisis, K., Georgopoulos, S., Giannoukas, A., Kiskinis, D., Machairas, A., Papavassiliou, V., Liapis, C. D., Antoniadis, P., Bessias, N., Giannakopoulos, T. G., Kaperonis, E., Klonaris, C., Saleptsis, V., Saratzis, N., Seretis, K., & Tampakis, C. (2014). Predictors affecting in-hospital mortality of ruptured abdominal aortic aneurysms: a Greek multicenter study. Annals of Vascular Surgery, 28(6), 1384-90. https://doi.org/10.1016/j.avsg.2013.12.028
Antonopoulos CN, et al. Predictors Affecting In-hospital Mortality of Ruptured Abdominal Aortic Aneurysms: a Greek Multicenter Study. Ann Vasc Surg. 2014;28(6):1384-90. PubMed PMID: 24517989.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors affecting in-hospital mortality of ruptured abdominal aortic aneurysms: a Greek multicenter study. AU - Antonopoulos,Constantine N, AU - Kakisis,John D, AU - Andrikopoulos,Vasilios, AU - Dervisis,Konstantinos, AU - Georgopoulos,Sotirios, AU - Giannoukas,Athanasios, AU - Kiskinis,Dimitrios, AU - Machairas,Anastasios, AU - Papavassiliou,Vasilios, AU - Liapis,Christos D, AU - Antoniadis,Pavlos, AU - Bessias,Nikolaos, AU - Giannakopoulos,Triantafillos G, AU - Kaperonis,Elias, AU - Klonaris,Christos, AU - Saleptsis,Vasilios, AU - Saratzis,Nikolaos, AU - Seretis,Konstantinos, AU - Tampakis,Charalambos, Y1 - 2014/02/08/ PY - 2013/08/19/received PY - 2013/11/20/revised PY - 2013/12/29/accepted PY - 2014/2/13/entrez PY - 2014/2/13/pubmed PY - 2015/10/1/medline SP - 1384 EP - 90 JF - Annals of vascular surgery JO - Ann Vasc Surg VL - 28 IS - 6 N2 - BACKGROUND: Endovascular aortic repair (EVAR) is being used with increasing frequency for the treatment of ruptured abdominal aortic aneurysms (rAAAs), although conflicting results have been reported concerning perioperative mortality. The aim of our study was to evaluate potential difference in mortality rates between EVAR and open surgical repair (OSR) and identify independent risk factors for in-hospital mortality in rAAAs. This study also aimed to evaluate the Glasgow Aneurysm Score (GAS) in predicting in-hospital mortality. A time-trend analysis of EVAR for ruptured AAAs was also performed. METHODS: Prospectively collected data from 7 public hospitals in Greece concerning rAAA repairs between January 2006 and April 2012 were analyzed. Primary outcome was in-hospital mortality. Multivariate logistic regression analysis was used to identify independent risk factors. The receiver-operator characteristic curve was used to determine the value of the GAS in predicting in-hospital death. Time-trend analysis, depicting annual changes (%), concerning EVAR for ruptured AAAs was also conducted. RESULTS: A total of 418 patients (92.3% men, mean age = 74.3 ± 8.8) with rAAAs were recorded during the study period. Among them, 113 patients (27%) underwent EVAR. Overall in-hospital mortality was 45.2%, whereas in-hospital mortality after EVAR and OSR was 20.4% and 54.3%, respectively (P < 0.001). Multivariate analysis evidenced that hemodynamic instability (P < 0.001), OSR (P < 0.001), age ≥80 years (P < 0.001), coronary artery disease (P < 0.001), and renal insufficiency (P = 0.02) independently increased in-hospital mortality. Area under the curve of GAS was 0.80 (95% confidence interval [CI] = 0.75-0.85, P < 0.001) for OSR and 0.64 (95% CI = 0.51-0.77, P = 0.04) for EVAR. Annual increase of proportion (%) of EVAR for rupture was 5% (P = 0.004). CONCLUSIONS: EVAR is being used with increasing frequency for the treatment of rAAAs and it appears to be associated with lower in-hospital mortality compared with OSR, after adjustment for hemodynamic instability and known atherosclerotic risk factors. Preoperative predictors of in-hospital mortality such as GAS should be probably modified in these patients. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/24517989/Predictors_affecting_in_hospital_mortality_of_ruptured_abdominal_aortic_aneurysms:_a_Greek_multicenter_study_ DB - PRIME DP - Unbound Medicine ER -