Intraoperative predictors of in-hospital mortality after open repair of ruptured abdominal aortic aneurysms.

IF 1.5 4区医学 Q3 PERIPHERAL VASCULAR DISEASE

International Angiology Pub Date : 2023-08-01 DOI:10.23736/S0392-9590.23.04941-6

Nicola Troisi, Giulia Bertagna, Athanasios Saratzis, Simone Guadagni, Fabrizio Minichilli, Daniele Adami, Mauro Ferrari, Raffaella Berchiolli

{"title":"Intraoperative predictors of in-hospital mortality after open repair of ruptured abdominal aortic aneurysms.","authors":"Nicola Troisi, Giulia Bertagna, Athanasios Saratzis, Simone Guadagni, Fabrizio Minichilli, Daniele Adami, Mauro Ferrari, Raffaella Berchiolli","doi":"10.23736/S0392-9590.23.04941-6","DOIUrl":null,"url":null,"abstract":"Background: Several models and scores have been released to predict early mortality in patients undergoing surgery for a ruptured abdominal aortic aneurysm (rAAA). These scores included above all preoperative factors and they could be useful to deny surgical repair. The aim of the study was to evaluate intraoperative predictors of in-hospital mortality in patients undergoing open surgical repair (OSR) for a rAAA.Methods: Between January 2007 and December 2020, 265 patients were admitted at our tertiary referral hospital for a rAAA. Two-hundred-twenty-two patients underwent OSR. Intra-operative factors were analyzed by means of univariate analysis (step 1). Associations of procedure variables with in-hospital mortality rates were sought based on a multivariate Cox regression analysis (step 2).Results: Overall, in-hospital mortality rate was 28.8% (64 cases). Multivariate Cox regression analysis reported that operation time >240 minutes (P=0.032, OR 2.155, CI 95% 1.068-4.349), and hemoperitoneum (P<0.001, OR 3.582, CI 95% 1.749-7.335) were negative predictive factors for in-hospital mortality. Patency of at least one hypogastric artery (P=0.010; OR 0.128, CI 95% 0.271-0.609), and infrarenal clamping (P=0.001; OR 0.157, CI 95% 0.052-0.483) had a protective role in reducing in-hospital mortality rate.Conclusions: Operation time >240 minutes, and hemoperitoneum affected in-hospital mortality in patients undergoing OSR for rAAA. Patency of at least one hypogastric artery, and infrarenal clamping had a protective role. Further studies are needed to validate these outcomes. A validated predictive model could be useful to help the physicians in communication with patients' relatives.","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"42 4","pages":"310-317"},"PeriodicalIF":1.5000,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Angiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.23736/S0392-9590.23.04941-6","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}

引用次数: 2

Abstract

Background: Several models and scores have been released to predict early mortality in patients undergoing surgery for a ruptured abdominal aortic aneurysm (rAAA). These scores included above all preoperative factors and they could be useful to deny surgical repair. The aim of the study was to evaluate intraoperative predictors of in-hospital mortality in patients undergoing open surgical repair (OSR) for a rAAA.

Methods: Between January 2007 and December 2020, 265 patients were admitted at our tertiary referral hospital for a rAAA. Two-hundred-twenty-two patients underwent OSR. Intra-operative factors were analyzed by means of univariate analysis (step 1). Associations of procedure variables with in-hospital mortality rates were sought based on a multivariate Cox regression analysis (step 2).

Results: Overall, in-hospital mortality rate was 28.8% (64 cases). Multivariate Cox regression analysis reported that operation time >240 minutes (P=0.032, OR 2.155, CI 95% 1.068-4.349), and hemoperitoneum (P<0.001, OR 3.582, CI 95% 1.749-7.335) were negative predictive factors for in-hospital mortality. Patency of at least one hypogastric artery (P=0.010; OR 0.128, CI 95% 0.271-0.609), and infrarenal clamping (P=0.001; OR 0.157, CI 95% 0.052-0.483) had a protective role in reducing in-hospital mortality rate.

Conclusions: Operation time >240 minutes, and hemoperitoneum affected in-hospital mortality in patients undergoing OSR for rAAA. Patency of at least one hypogastric artery, and infrarenal clamping had a protective role. Further studies are needed to validate these outcomes. A validated predictive model could be useful to help the physicians in communication with patients' relatives.

查看原文本刊更多论文

腹主动脉瘤开放性修复术后住院死亡率的术中预测因素。

背景:已经发布了几个模型和评分来预测腹主动脉瘤破裂(rAAA)手术患者的早期死亡率。这些评分包括以上所有术前因素，它们可能有助于拒绝手术修复。本研究的目的是评估接受开放式手术修复(OSR)的rAAA患者术中住院死亡率的预测因素。方法:2007年1月至2020年12月，我们三级转诊医院收治了265例rAAA患者。222例患者接受了OSR。采用单因素分析(步骤1)分析术中因素。采用多因素Cox回归分析(步骤2)寻找手术变量与住院死亡率的关系。结果:总体而言，住院死亡率为28.8%(64例)。多因素Cox回归分析显示，手术时间>240分钟(P=0.032, OR 2.155, CI 95% 1.068 ~ 4.349)、腹膜出血(P < 0.05)影响rAAA OSR患者住院死亡率。结论:手术时间>240分钟、腹膜出血影响rAAA OSR患者住院死亡率。至少一条腹下动脉通畅和肾下夹持具有保护作用。需要进一步的研究来验证这些结果。一个经过验证的预测模型可以帮助医生与患者家属沟通。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

International Angiology 医学-外周血管病

CiteScore

2.80

自引率

28.60%

发文量

审稿时长

6-12 weeks

期刊介绍： International Angiology publishes scientific papers on angiology. Manuscripts may be submitted in the form of editorials, original articles, review articles, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work. Duties and responsibilities of all the subjects involved in the editorial process are summarized at Publication ethics. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (ICMJE).