Patel, N., Piper, G., Chandela, S, Benckart, D., Young, J., Williams, K., Collela, J. and Healy, D.

Department of Surgery, Allegheny General Hospital, Pittsburgh, PA 15212

Little data exists in regards to long-term and functional outcome following rAAA repair. The present study provides such follow-up and defines the role of variables used to grade resuscitation efforts (base deficit (BD) and core temperature (cT)) as a correlate to improved survival. One hundred forty-seven patients presenting with rAAA from December 1993 to May 2001 were reviewed. Perioperative data, preexisting comorbidities and long-term follow up were obtained via retrospective chart review and phone interview. Overall, perioperative mortality was 35%(51/147) and mean age was 72 years. Of the remaining 96 patients, a minimum follow-up of 6 months was available for 63% (60/96). Both mean and median follow-up for this group was 25 months. Life table analysis revealed 1, 2 and 3 year survival to be 96%, 85% and 85% respectively. Eighty-three percent of patients reported a quality of life equal to that of their preoperative status. By univariant analysis (student t-test) both cT(p=0.02) and BD (p=0.03) at arrival were significantly associated with perioperative mortality. Using repeated measures analysis (ANOVA), cT remained a significant factor (p=0.006) associated with survival. Smoking history, hypertension, diabetes, COPD, mode of transportation and surgeon's specialty training were not significant variables. Based on this data, perioperative mortality following rAAA repair is best correlated to cT and BD. These measures are easily attained and should be aggressively corrected. Despite the advanced age of the present cohort of patients, an acceptable perioperative mortality rate and 2 as well as 3 year survival was attained. Following initial recovery, the majority of patients resumed a lifestyle comparable to their preoperative state. While the morbidity of rAAA can not be understated, long-term longitudinal follow-up suggests that aggressive management results in excellent functional outcome.



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