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Updated risk score can guide ruptured AAA procedures
Researchers published an updated risk score for patients with ruptured abdominal aortic aneurysms that incorporates the rise in endovascular procedures for the condition.
The condition is often fatal, and the score can predict whether a patient is likely to survive a surgical or endovascular procedure.
“In cases where mortality is expected to be 100%, initiating comfort care allows the family to spend time with the patient as opposed to risking the patient dying during transport while the family drives to the hospital,” Brandon T. Garland, MD, vascular surgeon at the University of Washington, Seattle, said in a press release.
Previous risk scores are based on outdated data that are compiled from before the advent of endovascular ruptured AAA repair or that rely on intra-operative information only, according to the release.
Garland and colleagues conducted a retrospective analysis of 303 patients with ruptured AAA (80% men; 50% older than 76 years) who underwent an open or endovascular repair at the University of Washington’s Harborview Medical Center between 2002 and 2013. In the overall cohort, 70% of patients underwent open repair, but after 2007, when the institution adopted an “endovascular first” approach, 53% of patients underwent endovascular repair.
Among the cohort, 16 patients died in the ED, en route to the procedure or after choosing comfort care. The overall 30-day mortality rate was 49%. The researchers identified the following predictors of mortality:
- age older than 76 years: OR = 2.11; 95% CI, 1.41-4.97;
- creatinine concentration > 2 mg/dL: OR = 3.66; 95% CI, 1.85-7.24;
- pH < 7.2: OR = 2.58; 95% CI, 1.27-5.24; and
- systolic BP < 70 mm Hg at any point: OR = 2.7; 95% CI, 1.46-4.97.
All patients were given 1 point for each of those variables, resulting in a risk score of 0 to 4.
At 30 days, mortality rates were 29% for those with 0 points, 22% for those with 1 point, 69% for those with 2 points, 80% for those with 3 points and 100% for those with 4 points, Garland and colleagues wrote.
Endovascular repair conferred a predicted mortality benefit across all scores, except in those with 4 points, none of whom had endovascular repair (0 points: endovascular 28%, open 30%; 1 point: endovascular 7%, open 30%; 2 points: endovascular 37%, open 80%; 3 points: endovascular 70%, open 82%), according to the researchers.
“In presenting referring providers with this information about our mortality rates under varying conditions, it is usually well received,” Garland said in the release. “The physicians now have data to tell the patients and their families that transfer may be futile. The cost of transport from these hospitals may be avoided as well as the operating room costs that occur when the family is presented with the bill after their loved one has died.” – by Erik Swain
Disclosure: The authors report no relevant financial disclosures.