### Description

The risk of perioperative mortality associated with elective repair of an abdominal aortic aneurysm can be predicted using a score developed by Steyerberg et al. This can help inform the patient of the risks associated with the surgery.

NOTE: I don't think these rates apply to endoluminal repair.

Parameters:

(1) surgeon or center-specific average operative mortality

(2) age of the patient in years

(3) gender of the patient

(4) cardiac comorbidity, based on myocardial infarction, congestive heart failure and ECG evidence of ischemia (ST segment depression > 2 mm)

(5) renal comorbidity

(6) pulmonary comorbidity

 Parameter Finding Points center/surgeon-specific average operative mortality 3% -5 4% -2 5% 0 6% +2 8% +5 12% +10 age in years 60 -4 70 0 80 +4 gender male 0 female +4 history of myocardial infarction present +3 absent 0 congestive heart failure present +8 absent 0 ECG evidence of ischemia present +8 absent 0 renal comorbidity creatinine <= 1.8 mg/dL 0 creatinine > 1.8 mg/dL +12 pulmonary comorbidity COPD and/or dyspnea present +7 both absent 0

where:

• Points for age is assigned with 1 point change for every 2.5 years (page 2002). I am not sure if this extends below 60 years or above 80 years. In the implementation I left them fixed at –4 and +4 respectively.

• If the surgeon's/center's mortality from 5% to 12% is placed in JMP, the following equation fits the data:

points for surgeon's/center's mortality rate =

= (-0.0618 * ((surgeon's percent as a whole number)^2)) + (2.4672 * (surgeon's percent as a whole number)) – 10.7129

total score =

= SUM(points for all 6 parameters)

Interpretation:

• minimum score: -9

• maximum score: 56

• The higher the score the greater the risk of mortality.

 Total Score Mortality -5 1% 0 2% 5 3% 10 5% 15 8% 20 12% 25 19% 30 28% 35 39% 40 51%

An equation approximating this data derived in JMP:

probability of mortality =

= (0.0003497 * ((score)^3)) + (0.013613 * ((score)^2)) + (0.140909 * (score)) + 1.697436

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