The Glasgow Aneurysm Score does not predict mortality after open abdominal aortic aneurysm in the era of endovascular aneurysm repair

Patterson, Benjamin O.; Karthikesalingam, Alan; Hinchliffe, Robert J.; Loftus, Ian; Thompson, Matt; Holt, Peter

doi:10.1016/j.jvs.2011.01.029

Cited by 24 publications

(18 citation statements)

References 16 publications

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“…Another drawback of the GAS is that it does not reliably identify individual high-risk patients due to a low-positive predictive value. 6 These are in contrast to the risk index proposed in the present study, which provides an estimate of perioperative mortality in an individual patient and has a relatively higher c-statistic of 0.72.…”

Section: Discussioncontrasting

confidence: 69%

“…Its discriminative power in terms of c-statistic in various validation studies, however, has gradually fallen over the last decade from 0.80 in 2003 to 0.63 this year, which is only slightly better than chance. 6,14 This is probably because while the GAS was developed in a period of open repair, endovascular repair has now become more prevalent, with open aortic surgery limited to complex aortic anatomy or morphology. Another drawback of the GAS is that it does not reliably identify individual high-risk patients due to a low-positive predictive value.…”

Section: Discussionmentioning

confidence: 99%

“…5 A study published recently, however, showed GAS to have a discriminative ability only slightly better than chance for mortality after elective oAAA repair. 6 The authors concluded that in the era of EVAR, it was possible that the GAS no longer accurately predicts the outcome after oAAA repair.…”

Section: Introductionmentioning

confidence: 99%

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Development of a risk index for prediction of mortality after open aortic aneurysm repair

Ramanan

Gupta

Sundaram

et al. 2013

Journal of Vascular Surgery

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Objective Open infrarenal aortic aneurysm (oAAA) repair is associated with significant morbidity and mortality. While there has been a shift towards endovascular repair, many patients continue to undergo an open repair due to anatomical considerations. Tools currently existing for estimation of peri-procedural risk in patients undergoing open aortic surgery have certain limitations. The objective of this study was to develop a risk index to estimate the risk of 30-day perioperative mortality after elective oAAA repair. Methods Patients who underwent elective oAAA repair (n=2845) were identified from the American College of Surgeons’ 2007-09 National Surgical Quality Improvement Program (NSQIP) - a prospective database maintained at multiple centers (>250). Univariable and multivariable analyses were performed to evaluate risk factors associated with 30-day mortality after oAAA repair and a risk index was developed. Results The 30-day mortality after oAAA repair was 3.3%. On multivariable analysis, six preoperative predictors of mortality were identified and a risk index was created by assigning weighted points to each predictor using the beta-coefficients from the regression analysis. The predictors included dyspnea (at rest: 8 points; on moderate exertion: 2 points; none: 0 points), history of peripheral arterial disease requiring revascularization or amputation (3 points), age >65 years (3 points), preoperative creatinine >1.5 mg/dl (2 points), female gender (2 points), and platelets < 150,000/mm3 or >350,000/mm3 (2 points). Patients were classified as low (<7%), intermediate (7-15%), and high (>15%) risk for 30-day mortality, based on a total point score of <8, 8-11, and >11, respectively. There were 2508 (88.2%) patients in the low risk category, while there were 278 (9.8%) patients in the intermediate, and 59 (2.1%) patients in the high risk category. Conclusions This risk index has excellent predictive ability for mortality after oAAA surgery and awaits validation in subsequent studies. It is anticipated to aid patients and surgeons in informed patient consent, preoperative risk assessment and optimization.

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Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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Development of a risk index for prediction of mortality after open aortic aneurysm repair

Ramanan

Gupta

Sundaram

et al. 2013

Journal of Vascular Surgery

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“…Second, existing scoring systems have not been validated consistently or robustly. 16–19 Third, it is not known if published prediction models are accurate in the current era, which incorporates the increasing and preferential use of endovascular repair (EVAR) of RAAAs when possible. 1,3 In modern practice, patients may be selected for open repair because they have difficult anatomy or hemodynamic instability, which makes them unsuitable for EVAR.…”

mentioning

confidence: 99%

“…In addition, patients currently treated with open repair may be at higher baseline risk than those treated with EVAR, which confounds comparisons of current outcomes. 1,19–21 Our objective was to examine the mortality and clinical variables that correlated with mortality after open repair of RAAA in a contemporary U.S. regional cohort, the Vascular Study Group of New England (VSGNE). We sought to develop a practical risk score for prediction of in-hospital mortality after open repair RAAA using prospectively acquired data from the VSGNE and to compare the performance of this risk score to existing scoring systems.…”

mentioning

confidence: 99%

Derivation and validation of a practical risk score for prediction of mortality after open repair of ruptured abdominal aortic aneurysms in a U.S. regional cohort and comparison to existing scoring systems

Robinson

Schanzer

et al. 2013

Journal of Vascular Surgery

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Objective Scoring systems for predicting mortality after repair of ruptured abdominal aortic aneurysms (RAAAs) have not been developed or tested in a United States population and may not be accurate in the endovascular era. Using prospectively collected data from the Vascular Study Group of New England (VSGNE), we developed a practical risk score for in-hospital mortality after open repair of RAAAs and compared its performance to that of the Glasgow aneurysm score, Hardman index, Vancouver score, and Edinburg ruptured aneurysm score. Methods Univariate analysis followed by multivariable analysis of patient, prehospital, anatomic, and procedural characteristics identified significant predictors of in-hospital mortality. Integer points were derived from the odds ratio (OR) for mortality based on each independent predictor in order to generate a VSGNE RAAA risk score, which was internally validated using bootstrapping methodology. Discrimination and calibration of all models were assessed by calculating the area under the receiver-operating characteristic curve (C-statistic) and applying the Hosmer-Lemeshow test. Results From 2003 to 2009, 242 patients underwent open repair of RAAAs at 10 centers. In-hospital mortality was 38% (n = 91). Independent predictors of mortality included age >76 years (OR, 5.3; 95% confidence interval [CI], 2.8–10.1), preoperative cardiac arrest (OR, 4.3; 95% CI, 1.6–12), loss of consciousness (OR, 2.6; 95% CI, 1.2–6), and suprarenal aortic clamp (OR, 2.4; 95% CI, 1.3–4.6). Patient stratification according to the VSGNE RAAA risk score (range, 0–6) accurately predicted mortality and identified those at low and high risk for death (8%, 25%, 37%, 60%, 80%, and 87% for scores of 0, 1, 2, 3, 4, and ≥5, respectively). Discrimination (C = .79) and calibration (χ2 = 1.96; P = .85) were excellent in the derivation and bootstrap samples and superior to that of existing scoring systems. The Glasgow aneurysm score, Hardman index, Vancouver score, and Edinburg ruptured aneurysm score correlated with mortality in the VSGNE cohort but failed to identify accurately patients with a risk of mortality >65%. Conclusions Existing scoring systems predict mortality after RAAA repair in this cohort but do not identify patients at highest risk. This parsimonious VSGNE RAAA risk score based on four variables readily assessed at the time of presentation allows accurate prediction of in-hospital mortality after open repair of RAAAs, including identification of those patients at highest risk for postoperative mortality.

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2017

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The Glasgow Aneurysm Score does not predict mortality after open abdominal aortic aneurysm in the era of endovascular aneurysm repair

Cited by 24 publications

References 16 publications

Development of a risk index for prediction of mortality after open aortic aneurysm repair

Development of a risk index for prediction of mortality after open aortic aneurysm repair

Derivation and validation of a practical risk score for prediction of mortality after open repair of ruptured abdominal aortic aneurysms in a U.S. regional cohort and comparison to existing scoring systems

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