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
Renal disease, age and outcome after aortic aneursym repair. BJS 2001; 88: 611-611.
Published: 6th December 2002
Authors: J. Refson, T. Wilmink, M. Kerle, W. Pillay, A. Mansfield, N. J. W. Cheshire et al.
Background
The safety of conventional aneurysm repair is undergoing increased scrutiny as less invasive methods are developed, certain high‐risk groups identified and the evidence for the risk of rupture is refined. An understanding of the relationship between preoperative risk factors and outcome is particularly important in elderly patients requiring a prophylactic operation.
Method
Risk factors (extent of aneurysm, ischaemic heart disease, renal function, hypertension, diabetes, serum cholesterol concentration, age and sex) were studied in 393 consecutive patients undergoing elective juxtarenal and infrarenal aneurysm repair between 1993 and 1999 (inclusive), and were related to hospital mortality.
Results
The overall mortality rate was 5·1 per cent (20 of 393). Multivariate logistic regression analysis revealed that age and creatinine concentration were independent risk factors for in‐hospital mortality. Extent of aneurysm was not an independent risk factor, nor was a history of myocardial ischaemia, sex, hypertension, diabetes or serum cholesterol level. The comparative risk related to age and serum creatinine concentration is shown in the Table. Values in parentheses are 95 per cent confidence intervals (c.i.)
Conclusion
Advances in preoperative and perioperative care appear to have reduced the significance of ischaemic heart disease and juxtarenal repair so that age and renal disease are currently major determinants of survival. In aneurysms of less than 7 cm in diameter, where the risk of rupture is less than 10 per cent per year, the natural history of the disease in elderly patients with renal failure appears to be more benign than the treatment. © 2001 British Journal of Surgery Society Ltd
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