Prediction of 30-day mortality after endovascular repair or open surgery in patients with ruptured abdominal aortic aneurysms
Received 15 October 2008; accepted 12 December 2008.
Objective
To validate the Glasgow Aneurysm Score (GAS) in patients with ruptured abdominal aortic aneurysms (AAAs) treated with endovascular repair or open surgery and to update the GAS so that it predicts 30-day mortality for patients with ruptured AAA treated with endovascular repair or open surgery.
Methods
In a multicenter prospective observational study, 233 consecutive patients with ruptured AAAs were evaluated; 32 patients did not survive to repair and statistical analysis was performed using collected data on 201 patients. All patients who were treated with endovascular repair (n = 58) or open surgery (n = 143) were included. The GAS was calculated for each patient. The area under the receiver operating characteristics curve (AUC) was used to indicate discriminative ability. We tested for interactions between risk factors and the procedure performed. The GAS was updated to predict 30-day mortality after endovascular repair or open surgery in patients with ruptured AAAs using logistic regression analysis.
Results
Thirty-day mortality was 15/58 (26%) for patients treated with endovascular repair and 57/143 (40%) for patients treated with open surgery (P = .06). The AUC for GAS was 0.69. No relevant interactions were found. The updated prediction rule (AUC = 0.70) can be calculated with the following formula: + 7 for open surgery + age in years + 17 for shock + 7 for myocardial disease + 10 for cerebrovascular disease + 14 for renal insufficiency.
Conclusion
We showed limited discriminative ability of the GAS and therefore updated the GAS by adding the type of procedure performed. This updated prediction rule predicts 30-day mortality for patients with ruptured AAAs treated with endovascular repair or open surgery.
aDepartment Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
bDepartment of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
eInstitute of Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Nijmegen, The Netherlands
cDepartment of Surgery, University Medical Center, Nijmegen, The Netherlands
dDepartment of Surgery, Catharina Hospital, Eindhoven, The Netherlands
Reprint requests: Marc R.H.M. van Sambeek, MD, PhD, Department of Surgery/Vascular Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
The study was funded by Erasmus MC Health Care Efficiency grant and an unrestricted educational grant from the “Lijf en Leven” Foundation.
Competition of interest: none.
⁎ 4A-Study Group: Jacob J. Visser, MD, PhD, Johanna L. Bosch, PhD, M.G. Myriam Hunink, MD, PhD, Joep A.W. Teijink, MD, PhD, Eric L.G. Verhoeven, MD, PhD, Martine Willems, MD, André A.E.A de Smet, MD, PhD, Jur Kievit, MD, Robert H. Geelkerken, MD, PhD, Ewout W. Steyerberg, PhD, Marc R.H.M. van Sambeek, MD, PhD.
ABSTRACT