Artikel
Do We Need a New Scoring System in Abdominal Aortic Aneurysm Repair? – Prospective Evaluation of the SVS/AAVS Comorbidity Severity Score compared to other risk scoring systems
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Autoren
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M. Gawenda
- Schwerpunkt Gefäßchirurgie, Klinikum der Universität zu Köln, Köln, Deutschland
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S. Schubert
- Schwerpunkt Gefäßchirurgie, Klinikum der Universität zu Köln, Köln, Deutschland
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G. Wassmer
- Institut für Medizinische Statistik und Epidemiologie; Klinikum der Universität zu Köln, Köln, Deutschland
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J. Brunkwall
- Schwerpunkt Gefäßchirurgie, Klinikum der Universität zu Köln, Köln, Deutschland
| Veröffentlicht: | 1. Oktober 2007 |
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Gliederung
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Introduction: Decision making in abdominal aortic aneurysm repair with either open or endovascular procedure is influenced by the natural course of disease and to the peri-operative mortality. Therefore, risk evaluation by scoring systems could be of value for the choice of the individual therapy. Aim of the presented study was to compare the value of the SVS/AAVS Comorbidity Severity Score (CSS) and two different preoperative risk scoring systems („American Society of Anaesthesiologists Physical Status Classification Scale“ - ASA; „Glasgow Aneurysm score“ - GAS).
Materials and methods: Between January 2003 and December 2005 the CSS was prospectively applied to 237 patients undergoing abdominal aortic aneurysm repair, electively performed in 187 cases. Additionally, comparison was made to the classification of „American Society of Anaesthesiologists Physical Status Classification Scale“ (ASA), and the „Glasgow Aneurysm score“ (GAS). The scorings were correlated to each other and to the mortality, the morbidity, and the length of postoperative hospital stay (LOS).
Results: Patients with electively performed open repair (OR) (n=109, tube grafts, bifurcated grafts) showed a CSS of 8.1±5.4, ASA-Score of 2.65±0.9, and GAS of 74.9±12.7. In elective endovascular repair (EVAR) (n=78, all bifurcated grafts) corresponding scorings were 10.3±5.3 (p<0.05), 2.6±0.9 (n. s.), and 79.4±11.3 (p<0.05). Patients with elective OR stayed significantly longer in the hospital (13.3±12.0 versus 8.3±5.0 days; p<0.05). Mortality was 2.8 percent (OR) and zero (EVAR) (n. s.). Morbidity rate (cardiac, pulmonary, and/or renal complications with therapeutic implications) was 10.1 percent (OR) and 9.0 percent (EVAR) (n. s.).
Discussion: The newly developed SVS/AAVS Comorbidity Severity Score demonstrated the high risk profile of the endovascularly treated patients with abdominal aortic aneurysms as did the older scorings systems do. But there was no correlation demonstrable to mortality or morbidity. There is still a lack of scoring system which determines the individual risk of AAA repair preoperatively.
