Ulus Travma Acil Cerrahi Derg. 2023; 29(11): 1261-1268 | DOI: 10.14744/tjtes.2023.82770

Pre-operative predictors of mortality in ruptured abdominal aortic aneurysms: is the Harborview Medical Center mortality risk score enough?

Semih Murat Yücel¹, Fatih Çalýþkan^2
1Department of Cardiovascular Surgery, Ondokuz Mayýs University, Faculty of Medicine, Samsun-Türkiye
²Department of Emergency Medicine, Ondokuz Mayýs University, Faculty of Medicine, Samsun-Türkiye

BACKGROUND: We aimed to evaluate the reliability of the Harborview Medical Center (HMC) mortality risk scoring system in predicting post-operative in-hospital mortality after open repair (OR) of a ruptured abdominal aortic aneurysm (rAAA) and to inves-tigate the presence of other possible mortality risk factors.
METHODS: Patients who underwent OR for rAAA between January 01, 2004, and December 31, 2021, were retrospectively included in this single-center cohort study. The 30-day hospital mortality risk was calculated using the HMC risk scoring system. We as-sessed the relationship between mortality and other perioperative variables. Logistic regression analysis was performed to determine the factors affecting mortality. Receiver operating characteristic curve analysis was utilized to obtain the predictive value of the HMC mortality risk score.
RESULTS: A total of 91 patients were included in this study. A statistically significant difference existed between the patients who survived and those who died. Univariate logistic regression analysis of the pre-operative patient data revealed that the hematocrit, lactate, shock index values, admission type, loss of consciousness, and HMC risk score significantly affected post-operative mortal-ity. However, in the multivariate logistic regression analysis, only the HMC risk score was associated with post-operative mortality (P<0.001). The HMC risk score could predict 30-day mortality, with an AUC of 0.912 for all patients.
CONCLUSION: Our study showed that the HMC risk score could reliably predict in-hospital mortality, but it did not reveal any other parameters that further increased the reliability of this scoring system without compromising on its straightforward and practical calculation.

Keywords: Accuracy, mortality; open repair; risk score; ruptured abdominal aortic aneurysm.

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Rüptüre abdominal aort anevrizmalarýnda preoperatif mortalite öngörücüleri: Harborview Medical Center (HMC) mortalite risk skoru yeterli mi?

Semih Murat Yücel¹, Fatih Çalýþkan^2
1Ondokuz Mayýs Üniversitesi, Týp Fakültesi, Kalp Damar Cerrahisi Anabilim Dalý, Samsun, Türkiye
²Ondokuz Mayýs Týp Fakültesi Acil Týp Anabilim Dalý, Samsun, Türkiye

AMAÇ: Rüptüre abdominal aort anevrizmasýnýn (rAAA) açýk onarýmýndan sonra postoperatif hastane içi mortaliteyi öngörmede Harborview Týp Merkezi (HMC) mortalite risk skorlama sisteminin güvenilirliðini deðerlendirmeyi ve diðer olasý mortalite risk faktörlerinin varlýðýný araþtýrmayý amaçladýk
GEREÇ VE YÖNTEM: 01 Ocak 2004 ile 31 Aralýk 2021 tarihleri arasýnda rAAA nedeniyle açýk onarým yapýlan hastalar bu tek merkezli kohort çalýþmasýna retrospektif olarak dahil edildi. 30 günlük hastane mortalite riski, HMC risk skorlama sistemi kullanýlarak hesaplandý. Mortalite ve diðer perioperatif deðiþkenler arasýndaki iliþki incelendi. Mortaliteyi etkileyen faktörleri belirlemek için lojistik regresyon analizi yapýldý. HMC mortalite risk skorunun prediktif deðerini elde etmek için Ýþlem Karakteristik (Receiver Operating Characteristic) Eðrisi analizi kullanýldý.
BULGULAR: Bu çalýþmaya toplam 91 hasta dahil edildi. Hayatta kalan hastalar ile ölenler arasýnda istatistiksel olarak anlamlý bir fark vardý. Preope-ratif hasta verilerinin tek deðiþkenli lojistik regresyon analizi, hematokrit, laktat ve þok indeksi deðerlerinin, baþvuru þeklinin, bilinç kaybýnýn ve HMC risk skorunun postoperatif mortaliteyi anlamlý olarak etkilediðini ortaya koydu. Ancak çok deðiþkenli lojistik regresyon analizinde sadece HMC risk skoru postoperatif mortalite ile iliþkiliydi (p<0.001). HMC risk skoru, tüm hastalar için 0,912 AUC deðeri ile 30 günlük mortaliteyi tahmin edebilir. SONUÇ: Çalýþmamýz, HMC risk skorunun hastane içi mortaliteyi güvenilir bir þekilde tahmin edebileceðini gösterdi, ancak bu skorlama sisteminin kolay ve pratik hesaplanmasýndan ödün vermeden güvenilirliðini daha da artýran baþka parametreler ortaya koymadý.

Anahtar Kelimeler: Rüptüre abdominal aort anevrizmasý, mortalite; risk skoru; açýk onarým; doðruluk.

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