Aplicação do Glasgow Aneurysm Score como modelo preditivo de mortalidade em doentes com rutura de aneurisma da aorta abdominal

Abstract

Introduction

The updated Glasgow Aneurysm Score (uGAS), designed to predict mortality/morbidity perioperative after rAAA, proved to be a good predictor of short term results after treatment with conventional surgery (CC) and EVAR. The objectives were to characterize patients operated at rAAA and evaluate the applicability of uGAS in the population of a national tertiary institution with rEVAR capacity.

Methods

We did a retrospective analysis of patients operated in our service to rAAA between February/2011 to February/2015. The variables were obtained through a search in a database of the institution and included age; sex; presence of heart disease, cerebrovascular disease, acute/chronic kidney disease and preoperative shock. Perioperative mortality (30‐day or in‐hospital) was obtained. The risk score was applied retrospectively and expected mortality compared with the mortality that was obtained.

Results

89 patients were included. 49 (55%) were treated by CC and the remaining 40 (45%) by EVAR. 35% had heart disease, 12% cerebrovascular disease, kidney disease 45% and 25% preoperative shock. The average uGAS was 90.6 ± 16.7. There were no statistically significant differences between patients undergoing EVAR or CC respecting to uGAS (p = 0,105). Mortality at 30 days was 39.8% and was significantly lower in patients undergoing EVAR than in those undergoing CC (20% vs 55%; p = 0.001).

Patients who died were significantly younger (70 vs. 76 years, p = 0.031), had a higher prevalence of kidney disease (55% vs 45%; p = 0.008), shock (59% vs 41%; p = 0.033) and a higher uGAS (100 ± 12,5 vs 84.6 ± 16,3; p < 0.001). The mortality of patients with uGAS < = 85 was 14.3% and patients with uGAS > 85 was 56.6%.

Conclusion

The results demonstrate the applicability of the uGAS score for risk stratification in a National cohort of patients with RAAA that EVAR is an alternative available. However, since it was not possible to identify a cut‐off able to provide a mortality of 100% We point out that the use of scores comprises the risk of treating patients refusing that could possibly survive. Additionally, these results suggest that treatment of RAAA by EVAR is associated with better outcomes.