Outcome in Patients Requiring Renal Replacement Therapy After Open Surgical Repair for Ruptured Abdominal Aortic Aneurysm

Abstract

Objective: To determine the relationship between postoperative renal replacement therapy (RRT) and patient survival after open surgical repair (OR) of ruptured abdominal aortic aneurysm (rAAA). Methods: A retrospective review of consecutive patients who underwent OR for rAAA repair between January 2002 and July 2008 was performed. Early (<30days) and late (>30days) outcomes were assessed. Results: A total of 94 patients (69 men; median [range] age 73.8 [56-89] years) underwent OR of rAAA (infrarenal = 78, juxtarenal = 15, and suprarenal = 1). In-hospital mortality rate was 40% and mean (range) length of intensive care unit (ICU) stay was 9.3 (0-56) days. A total of 23 (24%) patients required postoperative RRT. In-hospital mortality rate was significantly higher (RRT: 87% (20 of 23) vs no RRT: 18 of 71 (25%), P < .0001) and ICU stay significantly longer (RRT: mean (range) days; 14.8 (1-44) vs no RRT: 7.5 (0-56), P = .04) in the RRT patients. On multivariate analysis, RRT (P = .0053) and/or inotropic support (P = .0033) were independent risk factors for death within 30 days of the index procedure. Conclusions: Renal replacement therapy following OR of rAAA is an independent risk factor for mortality.

Keywords

aortic aneurysm open surgical repair rupture renal replacement therapy acute renal failure survival

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References

Mofidi R. , Suttie SA , Howd A. , Dawson AR , Griffiths GD , Stonebridge PA Outcome from abdominal aortic aneurysms in Scotland, 1991-2006. Br J Surg. 2008;95(12):1475-1479.

Bradbury AW , Makhdoomi KR , Adam DJ , Murie JA , Jenkins AM , Ruckley CV Twelve-year experience of the management of ruptured abdominal aortic aneurysm . Br J Surg. 1997;84(12):1705-1707.

Ympa YP , Sakr Y. , Reinhart K. , Vincent JL Has mortality from acute renal failure decreased? A systematic review of the literature. Am J Med. 2005;118(8):827-832.

Chen JC , Hildebrand HD , Salvian AJ , Taylor DC , Strandberg S. , Myckatyn TM , Hsiang YN Predictors of death in nonruptured and ruptured abdominal aortic aneurysms . J Vasc Surg. 1996; 24(4):614-620.

Gordon AC , Pryn S. , Collin J. , Gray DW , Hands L. , Garrard C. Outcome in patients who require renal support after surgery for ruptured abdominal aortic aneurysm. Br J Surg. 1994;81(6): 836-838.

Barratt J. , Parajasingam R. , Sayers RD , Feehally J. Outcome of acute renal failure following surgical repair of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2000;20(2): 163-168.

Drott C. , Arfvidsson B. , Ortenwall P. , Lundholm K. Age-standardized incidence of ruptured aortic aneurysm in a defined Swedish population between 1952 and 1988: mortality rate and operative results. Br J Surg. 1992;79(2):175-179.

Bown MJ , Sutton AJ , Bell PR , Sayers RD A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Br J Surg. 2002;89(6):714-730 [Review].

Dardik A. , Burleyson GP , Bowman H. , et al. Surgical repair of ruptured abdominal aortic aneurysms in the state of Maryland: factors influencing outcome among 527 recent cases. J Vasc Surg. 1998;28(3):413-420.

10.

Rutledge R. , Oller DW , Meyer AA , Johnson GJ Jr. A statewide, population-based time-series analysis of the outcome of ruptured abdominal aortic aneurysm. Ann Surg. 1996;223(5):492-502; discussion 503-505.

11.

Chertow GM , Lazarus JM , Christiansen CL , et al. Preoperative renal risk stratification. Circulation . 1997;95(4):878-884.

12.

Conlon PJ , Stafford-Smith M. , White WD , et al. Acute renal failure following cardiac surgery. Nephrol Dial Transplant. 1999;14(5):1158-1162.

13.

Tambyraja AL , Murie JA , Chalmers RT Prediction of outcome after abdominal aortic aneurysm rupture. J Vasc Surg. 2008; 47(1):222-230.

14.

Braams R. , Vossen V. , Lisman BA , Eikelboom BC Outcome in patients requiring renal replacement therapy after surgery for ruptured and non-ruptured aneurysm of the abdominal aorta. Eur J Vasc Endovasc Surg. 1999;18(4):323-327.

15.

Harris LM , Faggioli GL , Fiedler R. , Curl GR , Ricotta JJ Ruptured abdominal aortic aneurysms: factors affecting mortality rates. J Vasc Surg. 1991;14(6):812-818.