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Background: Rupture of an abdominal aortic aneurysm (RAAA) is associated with a risk of death approaching 80%. Prediction of immediate postoperative death in this condition assumes obvious relevance because it may be helpful in preoperative risk stratification.
Methods: One hundred fourteen patients underwent emergency open repair of RAAA. Data were retrospectively collected, and preoperative risk assessment was done according to the Glasgow aneurysm score, the Hardman index, and the Chen calculated risk.
Results: Fifty-one patients (44.7%) died during the immediate postoperative period. The area under the receiver operating characteristics curve for the Glasgow aneurysm score, the Hardman index, and the Chen calculated risk was 0.906, 0.834, and 0.672, respectively. The mortality rate among patients with a Glasgow aneurysm score >85 was 88.9%, whereas in those with a lower score it was 15.9% (P < .0001). The mortality rate among patients with a Hardman index > or =2 was 81.1%, whereas it was 27.3% in those with a lower score (P < .0001). The mortality rate in patients with a Chen calculated mortality risk >37% was 62.0%, whereas it was 31.3% in those with a calculated risk < or =37% (P = .001).
Conclusions: The present study showed that the Glasgow aneurysm score and, to a somewhat lower extent, the Hardman score are valuable predictors of immediate postoperative death after emergency open repair of RAAA.
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| http://dx.doi.org/10.1016/j.amjsurg.2006.01.026 | DOI Listing |
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Article Synopsis
- The study investigates the use of intraoperative neurophysiological monitoring (IONM) during surgeries for blood-blister-like aneurysms (BBA), which are complicated due to high risks of complications and death.
- Researchers monitored patients using somatosensory and transcranial motor evoked potentials (SSEPs/tcMEPs) to assess neurological outcomes, revealing a low sensitivity (37.5%) but high specificity (100%) for detecting ischemic events during surgery.
- Results indicate that while IONM can accurately identify healthy brain function, it has a high rate of false negatives, particularly in complex surgical procedures, highlighting the need for careful interpretation and further studies.
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