A New Preoperative Predictor of Outcome in Ruptured Abdominal Aortic Aneurysms: The Time Before Shock (TBS)

Scarcello, Edoardo; Ferrari, Mauro; Rossi, Giuseppe; Berchiolli, Raffaella; Adami, Daniele; Romagnani, F; Mosca, Franco

doi:10.1016/j.avsg.2009.07.011

Cited by 13 publications

(9 citation statements)

References 14 publications

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“…Based on the risk factors mentioned above, there have been many efforts to decrease the postoperative mortality of RAAA 2-4,6,14,20-22. Kim, et al,2 Scarcello, et al4 and Beah, et al14 asserted that operations should be performed as soon as possible before preoperative cardiac arrest develops.…”

Section: Discussionmentioning

confidence: 99%

“…Kim, et al,2 Scarcello, et al4 and Beah, et al14 asserted that operations should be performed as soon as possible before preoperative cardiac arrest develops. Cho, et al3 reported the importance of a prompt diagnosis and recovery from a shock state by fluid resuscitation and transfusion, and they suggested that the rapid infusion system could be useful in this situation.…”

Section: Discussionmentioning

confidence: 99%

“…And, it has been reported that if the diameter of AAA is more than 5.5 cm, the risk of rupture of AAA is increased; if the diameter of AAA is more than 6.5 cm, the risk of rupture of AAA is greatly increased 3. Despite significant improvements in surgery, anesthesia, and postoperative critical care, the mortality rate of ruptured AAA (RAAA) has not changed substantially over the last two decades 4,5. According to most reports,3,6,7 the postoperative mortality rate of RAAA has remained at 40-50%, reaching 75-90% if deaths occurring before patients' arrival at the hospital are included.…”

Section: Introductionmentioning

confidence: 99%

“…The primary causes of death in patients undergoing emergency repair of RAAA, in most reports, are massive hemorrhage, cardiorespiratory dysfunction, and acute renal failure (ARF) 8. With respect to the high mortality rate of RAAA, Scarcello, et al4 asserted that time before shock was the most important predictor of the postoperative mortality for RAAA, while Davies, et al8 reported postoperative renal replacement therapy (RRT) as an independent risk factor of RAAA, and Halpern, et al9 argued that loss of consciousness, preoperative hemoglobin level, preoperative and intraoperative systolic blood pressure, intraoperative urine output, intraoperative blood loss, and intraoperative transfusion were risk factors of the mortality of RAAA. Similar to these, various authors have reported different factors as risk factors of the postoperative mortality of RAAA 4,8,9.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Postoperative Mortality of Ruptured Abdominal Aortic Aneurysm: A Retrospective Clinical Study

et al. 2012

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PurposeDespite significant improvements in surgery, anesthesia, and postoperative critical care, the postoperative mortality rate of ruptured abdominal aortic aneurysm (RAAA) has remained at 40% to 50% for several decades. Therefore, we evaluated factors associated with the postoperative mortality of RAAA.Materials and MethodsFrom January 1999 to December 2008, a retrospective study was performed with 34 patients who underwent open repair of RAAA. The preoperative factors included age, sex, smoking, comorbidities, serum creatinine, hemoglobin, shock, pulse rate, and time from emergency room to operation room. The intraoperative factors included blood loss, transfusion, aortic clamping site and time, aneurysmal characteristics, rupture type, graft type, hourly urine output (HUO), and operative time. The postoperative factors included inotropic support, renal replacement therapy (RRT), reoperation, bowel ischemia, multiple organ failure (MOF), and intensive care unit stay. The 2-day and the 30-day mortality rates were analyzed separately.ResultsThe 2-day and the 30-day mortality rates were 14.7% and 41.2%, respectively. On univariate analysis, shock, transfusion, HUO, inotropic support and MOF for the 2-day mortality and serum creatinine, transfusion, aortic clamping site, HUO, inotropic support, RRT and MOF for the 30-day mortality were statistically significant. On multivariate analysis, shock, inotropic support and MOF for the 2-day mortality and aortic clamping site, RRT and MOF for the 30-day mortality were statistically significant.ConclusionTo decrease the postoperative mortality rate of RAAA, prevention of massive hemorrhage and acute renal failure with infrarenal aortic clamping, as well as prompt operative control of bleeding and maintenance of systemic perfusion are important.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of Postoperative Mortality of Ruptured Abdominal Aortic Aneurysm: A Retrospective Clinical Study

et al. 2012

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“…There have been various studies of the perioperative mortality rate and its different risk factors in rAAA patients. Scarcello et al [3] reported that the time before shock is the most important predictor of rAAA mortality, whereas Davies et al [4] reported that postoperative renal replacement therapy is a risk factor for rAAA mortality. Antonopoulos et al [5] reported that age, coronary artery disease, chronic renal failure, hemodynamic instability, and open surgical repair are risk factors that affect death from rAAA.…”

Section: Introductionmentioning

confidence: 99%

Analysis of in hospital mortality and long-term survival excluding in hospital mortality after open surgical repair of ruptured abdominal aortic aneurysm

et al. 2016

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PurposeThe aim of this study was to confirm the factors that affect the mortality associated with the open surgical repair of ruptured abdominal aortic aneurysm (rAAA) and to analyze the long-term survival rates.MethodsA retrospective review was performed on a prospectively collected database that included 455 consecutive patients who underwent open surgical repair for AAA between January 2001 and December 2012. We divided our analysis into in-hospital and postdischarge periods and analyzed the risk factors that affected the long-term survival of rAAA patients.ResultsOf the 455 patients who were initially screened, 103 were rAAA patients, and 352 were non-rAAA (nAAA) patients. In the rAAA group, 25 patients (24.2%) died in the hospital and 78 were discharged. Long-term survival was significantly better in the nAAA group (P = 0.001). The 2-, 5-, and 10-year survival rates of the rAAA patients were 87%, 73.4%, and 54.1%, respectively. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.02–.08; P < 0.001) and aneurysm rupture (HR, 1.96; 95% CI, 1.12–.44; P = 0.01) significantly affected long-term survival.ConclusionPreoperative circulatory failure is the most common cause of death for in-hospital mortality of rAAA patients. After excluding patients who have died during the perioperative period, age is the only factor that affects the survival of rAAA patients.

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Updates in the Management of Non-traumatic Abdominal Vascular Emergencies (Abdominal Aortoiliac Aneurysms, Intestinal Ischemia, Splanchnic Aneurysms)

Tracanelli

Occhiuto

Vercelli

et al. 2019

Operative Techniques and Recent Advances in Acute Care and Emergency Surgery

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A New Preoperative Predictor of Outcome in Ruptured Abdominal Aortic Aneurysms: The Time Before Shock (TBS)

Cited by 13 publications

References 14 publications

Predictors of Postoperative Mortality of Ruptured Abdominal Aortic Aneurysm: A Retrospective Clinical Study

Predictors of Postoperative Mortality of Ruptured Abdominal Aortic Aneurysm: A Retrospective Clinical Study

Analysis of in hospital mortality and long-term survival excluding in hospital mortality after open surgical repair of ruptured abdominal aortic aneurysm

Updates in the Management of Non-traumatic Abdominal Vascular Emergencies (Abdominal Aortoiliac Aneurysms, Intestinal Ischemia, Splanchnic Aneurysms)

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