Factors affecting survival after ruptured abdominal aortic aneurysm.

To identify the factors affecting the high mortality rates associated with ruptured abdominal aortic aneurysm (AAA), a review was made of the records of 81 patients treated surgically between 1972 and 1983. Correlation of data with survival and predictive value of preoperative findings were studied. The mortality rate was 43.2%; there was a 29.2% mortality rate among those surviving the day of surgery. Patient-determined variables associated with deaths included age more than 76 years, hematocrit less than 30% and acute abnormality detected by ECG at admission, and suprarenal extension or free rupture of the AAA. Survival could be predicted with only 70% accuracy with a computerized discriminant function based on age and hematocrit and blood pressure values determined at admission. Events following admission associated with death were precipitous fall or persistently low level of preoperative blood pressure, technical complications, and postoperative organ failure. Although the patient's ultimate outcome after ruptured AAA is partly determined before intervention of the physician, efforts to address events resulting in death after admission by improving rapid diagnosis, early resuscitation, and prompt flawless surgery can increase survival.