Preoperative factors affecting long-term mortality in patients survived to ruptured abdominal aortic aneurysm repair

Troisi, Nicola; Isernia, Giacomo; Bertagna, Giulia; Adami, Daniele; Baccani, Luigi; Parlani, Gianbattista; Berchiolli, Raffaella; Simonte, Gioele

doi:10.23736/s0392-9590.23.05058-7

Cited by 2 publications

(3 citation statements)

References 42 publications

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“…Indeed, almost all previous mortality risk scores focused on the identification of preoperative factors possibly affecting mortality in rAAA patients to predict perioperative outcomes after surgery, be it open or endovascular. Moreover, several studies concentrated on the identification of preoperative parameters influencing long-term survival [ 18 , 19 , 20 ]. Prediction models were mainly developed to aid the decision regarding whether lifesaving treatment should be withheld.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative Predictors and Proposal for a Novel Prognostic Risk Score for In-Hospital Mortality after Open Repair of Ruptured Abdominal Aortic Aneurysms (SPARTAN Score)

Berchiolli,

Troisi,

Bertagna

et al. 2024

JCM

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(1) Background: Several mortality risk scores have been developed to predict mortality in ruptured abdominal aortic aneurysms (rAAAs), but none focused on intraoperative factors. The aim of this study is to identify intraoperative variables affecting in-hospital mortality after open repair and develop a novel prognostic risk score. (2) Methods: The analysis of a retrospectively maintained dataset identified patients who underwent open repair for rAAA from January 2007 to October 2023 in three Italian tertiary referral centers. Multinomial logistic regression was used to calculate the association between intraoperative variables and perioperative mortality. Independent intraoperative factors were used to create a prognostic score. (3) Results: In total, 316 patients with a mean age of 77.3 (SD ± 8.5) were included. In-hospital mortality rate was 30.7%. Hemoperitoneum (p < 0.001), suprarenal clamping (p = 0.001), and operation times of >240 min (p = 0.008) were negative predictors of perioperative mortality, while the patency of at least one hypogastric artery had a protective role (p = 0.008). Numerical values were assigned to each variable based on the respective odds ratio to create a risk stratification for in-hospital mortality. (4) Conclusions: rAAA represents a major cause of mortality. Intraoperative variables are essential to estimate patients’ risk in surgically treated patients. A prognostic risk score based on these factors alone may be useful to predict in-hospital mortality after open repair.

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Section: Discussionmentioning

confidence: 99%

“…Other definitions of clinical events and/or imaging parameters were in accordance with the reporting standards of the Society for Vascular Surgery [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

Intraoperative Predictors and Proposal for a Novel Prognostic Risk Score for In-Hospital Mortality after Open Repair of Ruptured Abdominal Aortic Aneurysms (SPARTAN Score)

Berchiolli,

Troisi,

Bertagna

et al. 2024

JCM

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“…More recently, Troisi and coworkers also analyzed and identified several intraoperative and pre-operative factors associated with in-hospital mortality [62] and long-term survival [63] (in those alive after 90 days from the index operation) for patients undergoing repair of an rAAA. Although they did not develop a specific risk prediction model, they were able to discriminate important variables (such as salvaging at least one hypogastric artery) that were likely missed by most registries before.…”

Section: Discussionmentioning

confidence: 99%

Risk Prediction Models for Peri-Operative Mortality in Patients Undergoing Major Vascular Surgery with Particular Focus on Ruptured Abdominal Aortic Aneurysms: A Scoping Review

Grandi,

Bertoglio,

Lepidi

et al. 2023

JCM

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Purpose. The present scoping review aims to describe and analyze available clinical data on the most commonly reported risk prediction indices in vascular surgery for perioperative mortality, with a particular focus on ruptured abdominal aortic aneurysm (rAAA). Materials and Methods. A scoping review following the PRISMA Protocols Extension for Scoping Reviews was performed. Available full-text studies published in English in PubMed, Cochrane and EMBASE databases (last queried, 30 March 2023) were systematically reviewed and analyzed. The Population, Intervention, Comparison, Outcome (PICO) framework used to construct the search strings was the following: in patients with aortic pathologies, in particular rAAA (population), undergoing open or endovascular surgery (intervention), what different risk prediction models exist (comparison), and how well do they predict post-operative mortality (outcomes)? Results. The literature search and screening of all relevant abstracts revealed a total of 56 studies in the final qualitative synthesis. The main findings of the scoping review, grouped by the risk score that was investigated in the original studies, were synthetized without performing any formal meta-analysis. A total of nine risk scores for major vascular surgery or elective AAA, and 10 scores focusing on rAAA, were identified. Whilst there were several validation studies suggesting that most risk scores performed adequately in the setting of rAAA, none reached 100% accuracy. The Glasgow aneurysm score, ERAS and Vancouver score risk scores were more frequently included in validation studies and were more often used in secondary studies. Unfortunately, the published literature presents a heterogenicity of results in the validation studies comparing the different risk scores. To date, no risk score has been endorsed by any of the vascular surgery societies. Conclusions. The use of risk scores in any complex surgery can have multiple advantages, especially when dealing with emergent cases, since they can inform perioperative decision making, patient and family discussions, and post hoc case-mix adjustments. Although a variety of different rAAA risk prediction tools have been published to date, none are superior to others based on this review. The heterogeneity of the variables used in the different scores impairs comparative analysis which represents a major limitation to understanding which risk score may be the “best” in contemporary practice. Future developments in artificial intelligence may further assist surgical decision making in predicting post-operative adverse events.

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Preoperative factors affecting long-term mortality in patients survived to ruptured abdominal aortic aneurysm repair

Cited by 2 publications

References 42 publications

Intraoperative Predictors and Proposal for a Novel Prognostic Risk Score for In-Hospital Mortality after Open Repair of Ruptured Abdominal Aortic Aneurysms (SPARTAN Score)

Intraoperative Predictors and Proposal for a Novel Prognostic Risk Score for In-Hospital Mortality after Open Repair of Ruptured Abdominal Aortic Aneurysms (SPARTAN Score)

Risk Prediction Models for Peri-Operative Mortality in Patients Undergoing Major Vascular Surgery with Particular Focus on Ruptured Abdominal Aortic Aneurysms: A Scoping Review

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