This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Risk factors for postoperative death following elective surgical repair of abdominal aortic aneurysm: results from the UK Small Aneurysm Trial. BJS 2000; 87: 742-749.

Published: 6th December 2002

Authors: A. R. Brady, F. G. R. Fowkes, R. M. Greenhalgh, J. T. Powell, C. V. Ruckley, S. G. Thompson et al.

Background

In regional and population studies, the mortality rate within 30 days of elective surgical repair of abdominal aortic aneurysm is approximately 8 per cent. Identification of preoperative factors associated with this mortality risk is important for informing surgical policy and may suggest suitable preoperative interventions.

Method

In the UK Small Aneurysm Trial, 820 patients aged 60–80 years underwent elective open surgical repair of an abdominal aortic aneurysm. The relationship between 30‐day mortality rate and 13 prespecified potential prognostic factors was investigated. The value of a published clinical prediction rule was also evaluated.

Results

The postoperative mortality rate was 5·6 per cent overall (46 deaths in 820 patients). Postoperative mortality risk was significantly associated with older age (P = 0·03), higher serum creatinine level (P = 0·002) and lower forced expiratory volume in 1 s (FEV₁) (P = 0·003) in univariate analyses. Evidence of a relationship between age and postoperative death was weakened (P = 0·08) after adjustment for creatinine level and FEV₁. The predicted postoperative mortality risk ranged from 2·7 per cent in younger patients with below average creatinine levels and above average FEV₁, to 7·8 per cent in older patients with above average creatinine levels and below average FEV₁. The published clinical prediction rule did not validate well on these data; observed risk did not correlate with predicted risk except for a small group of high‐risk patients.

Conclusion

Poor preoperative lung and renal function was strongly associated with postoperative death. Age was less important once these two important prognostic factors had been taken into account. The potential for preoperative improvement in lung and renal function to reduce postoperative mortality rates should be addressed in future studies. © 2000 British Journal of Surgery Society Ltd

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