Open Repair for Ruptured Abdominal Aortic Aneurysm: Is It Possible to Predict Survival? M. Antonello, 1 P. Frigatti, 1 C. Maturi, 1 S. Lepidi, 1 F. Noventa, 2 G. Pittoni, 3 G.P. Deriu, 1 and F. Grego, 1 Padua, Italy The aim of the study was to determine variables that could be used to predict survival in patients with ruptured abdominal aortic aneurysm (RAAA) and to assess the accuracy of the Glasgow Aneurysm Score (GAS) and the Acute Physiology Chronic Health Evaluation II (APACHE-II). From January 1998 to July 2006, 103 patients underwent operations for RAAA. For each patient, 44 variables were retrospectively recorded in a database. Data were analyzed with univariate and multivariate methods. In the univariate analysis significant predictors of death were hypoten- sion ( p ¼ 0.001), preexisting peripheral vascular disease ( p < 0.001), renal insufficiency ( p ¼ 0.037), chronic obstructive pulmonary disease ( p ¼ 0.028), level of HCO 3 - ( p < 0.001), intraper- itoneal rupture ( p ¼ 0.001), blood transfused ( p < 0.001), cardiac complications ( p < 0.001), and APACHE-II score ( p ¼ 0.001). Multivariate analysis confirmed statistical significance for coexisting peripheral vascular disease ( p < 0.001), diastolic blood pressure at admission <60 mm Hg ( p ¼ 0.039), APACHE-II score >18.5 ( p ¼ 0.025), HCO 3 - <21 mg/dL ( p < 0.001), and intraperitoneal rupture of the aneurysm ( p ¼ 0.011) as predictors of death. Results of the study suggested that different factors can be helpful in identifying those patients whose operative risk is prohibitive. APACHE-II, contrary to GAS, is an accurate system to predict postoperative death after repair for RAAA. INTRODUCTION Despite the increase in numbers of elective abdom- inal aortic aneurysm (AAA) repair, the number of patients with ruptured AAA (RAAA) has not been significantly reduced. 1-3 Whereas the surgical mor- tality rate for elective repair of AAA has steadily im- proved by about 5%, the mortality rates after repair of RAAA have not significantly changed in the literature in the last three decades, still ranging 30- 50% in the most recent reports. 4-9 Many different factors have been advocated to be predictive of death, including age, comorbidity, medical condition, preoperative shock or hypoten- sion, increased creatinine level, low hemoglobin/ hematocrit level, and technical and postoperative complications; but none of these was really able to predict correctly the outcome of these pa- tients. 5,8,10-12 Scoring systems have been developed to identify those patients who are at high risk of postoperative mortality or morbidity; however, most of them are complex and not usable in the emergent setting. The Glasgow Aneurysm Score (GAS) has been proved to be a simple and effective method to identify preoperatively patients at high risk for emergent AAA repair. 13,14 The Acute Physi- ology Chronic Health Evaluation II (APACHE-II) model is the only available model specifically devel- oped for predicting outcome in the postoperative pe- riod for patients managed in the intensive unit care (IUC). 15,16 The aim of this retrospective study was to 1 Department of Cardiac, Thoracic, and Vascular Sciences, Vascular and Endovascular Surgery Section, University of Padua, Padua, Italy. 2 Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy. 3 Department of Anesthesiology and Reanimation, Azienda Ospeda- liera di Padova, Padua, Italy. Correspondence to: Michele Antonello, MD, PhD, Department of Cardiac, Thoracic, and Vascular Sciences, Vascular and Endovascular Surgery Section, University of Padua, Via Giustiniani 2, 35100 Padua, Italy, E-mail: michele.antonello.1@unipd.it Ann Vasc Surg 2009; 23: 159-166 DOI: 10.1016/j.avsg.2008.05.011 Ó Annals of Vascular Surgery Inc. Published online: October 1, 2008 159