Document Detail


The Glasgow Aneurysm Score does not predict mortality after open abdominal aortic aneurysm in the era of endovascular aneurysm repair.
MedLine Citation:
PMID:  21458200     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Endovascular aneurysm repair (EVAR) has reduced early adverse outcomes from abdominal aortic aneurysm (AAA) repair. Preferential use of EVAR may have altered the profile of patients who undergo open repair. The validity of scoring systems such as the Glasgow Aneurysm Score (GAS), devised when open surgery was the only treatment, required reappraisal.
METHODS: Patients were identified from a database of patients undergoing elective infrarenal aneurysm repair at seven United Kingdom centers, and the GAS was calculated for each patient. Discrimination and calibration were calculated to determine the performance of the model in this setting using the C statistic, tertile analysis, and the χ(2) test. Univariate analysis was performed to determine if a new iteration of the GAS could be produced.
RESULTS: We identified 330 patients who met the inclusion criteria. There were 18 deaths ≤30 days of surgery (5.4%). The average (standard deviation) GAS was 78.6 (8.8) for the survivors and 81.9 (10.4) for nonsurvivors (P = .122). The C statistic was 0.625 (95% confidence interval, 0.481-0.769; P = .75) suggesting a discriminatory ability not much better than chance alone. Despite this, calibration of the model was good. There was no significant difference in the comorbidities of either group, so no recalibration of the GAS could be performed.
CONCLUSION: The GAS did not discriminate between survivors and nonsurvivors after open AAA repair in this cohort. In the era of EVAR, it is possible that the GAS does not predict the outcome of open AAA repair. An alternative explanation is that patients with risk factors for poor outcomes from EVAR, such as adverse AAA morphology, are being selected out for open repair.
Authors:
Benjamin Oliver Patterson; Alan Karthikesalingam; Robert J Hinchliffe; Ian M Loftus; Matt M Thompson; Peter J E Holt
Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2011-03-31
Journal Detail:
Title:  Journal of vascular surgery     Volume:  54     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-08-08     Completed Date:  2011-10-24     Revised Date:  2014-03-14    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  353-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / diagnosis,  mortality*,  surgery*
Chi-Square Distribution
Endovascular Procedures / mortality*
Female
Great Britain / epidemiology
Health Status Indicators*
Humans
Male
Middle Aged
Predictive Value of Tests
ROC Curve
Reproducibility of Results
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Vascular Surgical Procedures / mortality*
Grant Support
ID/Acronym/Agency:
NIHR-CS-011-008//Department of Health

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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