Advertisement

Derivation and Validation of a Risk Score for Abdominal Compartment Syndrome after Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms

Published:March 23, 2022DOI:https://doi.org/10.1016/j.avsg.2022.03.014

      Background

      Abdominal compartment syndrome (ACoS) is a devastating complication after endovascular aneurysm repair for ruptured abdominal aortic aneurysms (rEVAR). This study sought to develop a risk score for ACoS to identify patients who would benefit from early decompressive laparotomy.

      Methods

      Model derivation was performed with Vascular Quality Initiative data for rEVAR from 2013 to 2020. The primary outcome was evacuation of abdominal hematoma. A multivariable logistic regression was used to create and validate a scoring system to predict ACoS. The model was validated using institutional data for rEVAR from 1998 to 2019.

      Results

      The derivation cohort included 2,310 patients with rEVAR. Abdominal hematoma evacuation occurred in 265 patients (11.5%). Factors associated with abdominal hematoma evacuation on a multivariable analysis included transfer from an outside hospital, preoperative creatinine ≥1.4 mg/dL, preoperative systolic blood pressure ≤85 mmHg, preoperative altered mental status, ≥3.0 liters intraoperative crystalloid, and ≥4 units of red blood cells transfused intraoperatively. The validation cohort consisted of 67 rEVAR; ACoS occurred in 8 patients (11.9%). The c-statistic was 0.84 in the derivation and 0.87 in the validation cohort, whereas Hosmer-Lemeshow was P = 0.15 in the derivation and 0.84 in the validation cohorts, suggesting good model discrimination and calibration. Points were applied based on β-coefficients to produce a risk score ranging from −1 to 13. A cutoff of risk score ≥8 resulted in a sensitivity and specificity of 87.5% and 83.1% for detecting patients with ACoS, respectively. ACoS conveyed a significantly higher mortality in both the derivation (ACoS: 49.8% vs. No ACoS: 17.8%; P < 0.001) and validation cohorts (ACoS: 75.0% vs. No ACoS: 15.2%; P < 0.001).

      Conclusions

      In patients with equivocal signs/symptoms of ACoS, this scoring system can be used to guide surgeons on when to perform decompressive laparotomy prior to leaving the operating room for rEVAR. Patients with a risk score ≥8 would benefit from decompressive laparotomy at index rEVAR.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chaikof E.L.
        • Dalman R.L.
        • Eskandari M.K.
        • et al.
        The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm.
        J Vasc Surg. 2018; 67: 2-77.e2
        • Ullery B.W.
        • Tran K.
        • Chandra V.
        • et al.
        Association of an endovascular-first protocol for ruptured abdominal aortic aneurysms with survival and discharge disposition.
        JAMA Surg. 2015; 150: 1058
        • Park B.D.
        • Azefor N.
        • Huang C.-C.
        • et al.
        Trends in treatment of ruptured abdominal aortic aneurysm: impact of endovascular repair and implications for future care.
        J Am Coll Surgeons. 2013; 216: 745-754
        • Edwards S.T.
        • Schermerhorn M.L.
        • O’Malley A.J.
        • et al.
        Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population.
        J Vasc Surg. 2014; 59: 575-582.e6
        • Sweeting M.J.
        • Ulug P.
        • Powell J.T.
        • et al.
        Ruptured aneurysm trials: the importance of longer-term outcomes and meta-analysis for 1-year mortality.
        Eur J Vasc Endovasc Surg. 2015; 50: 297-302
        • Noel A.A.
        • Gloviczki P.
        • Cherry Jr., K.J.
        • et al.
        Ruptured abdominal aortic aneurysms: the excessive mortality rate of conventional repair.
        J Vasc Surg. 2001; 34: 41-46
        • Harris L.M.
        • Faggioli G.L.
        • Fiedler R.
        • et al.
        Ruptured abdominal aortic aneurysms: factors affecting mortality rates.
        J Vasc Surg. 1991; 14: 812-820
        • Halpern V.J.
        • Kline R.G.
        • D’Angelo A.J.
        • et al.
        Factors that affect the survival rate of patients with ruptured abdominal aortic aneurysms.
        J Vasc Surg. 1997; 26: 939-948
        • Alonso-Perez M.
        • Segura R.
        • Sanchez J.
        • et al.
        Factors increasing the mortality rate for patients with ruptured abdominal aortic aneurysms.
        Ann Vasc Surg. 2001; 15: 601-607
        • Kirkpatrick A.W.
        • Roberts D.J.
        • De Waele J.
        • et al.
        Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome.
        Intensive Care Med. 2013; 39: 1190-1206
        • Karkos C.D.
        • Menexes G.C.
        • Patelis N.
        • et al.
        A systematic review and meta-analysis of abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysms.
        J Vasc Surg. 2014; 59: 829-842
        • Ersryd S.
        • Djavani-Gidlund K.
        • Wanhainen A.
        • et al.
        Editor’s Choice – abdominal compartment syndrome after surgery for abdominal aortic aneurysm: a Nationwide population based study.
        Eur J Vasc Endovascular Surg. 2016; 52: 158-165
        • Mehta M.
        • Taggert J.
        • Darling R.C.
        • et al.
        Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: outcomes of a prospective analysis.
        J Vasc Surg. 2006; 44: 1-8
        • Djavani K.
        • Wanhainen A.
        • Björck M.
        Intra-abdominal hypertension and abdominal compartment syndrome following surgery for ruptured abdominal aortic aneurysm.
        Eur J Vasc Endovasc Surg. 2006; 31: 581-584
        • Mayer D.
        • Rancic Z.
        • Meier C.
        • et al.
        Open abdomen treatment following endovascular repair of ruptured abdominal aortic aneurysms.
        J Vasc Surg. 2009; 50: 1-7
        • Cronenwett J.L.
        • Kraiss L.W.
        • Cambria R.P.
        The society for vascular surgery vascular quality Initiative.
        J Vasc Surg. 2012; 55: 1529-1537
        • Cronenwett J.L.
        • Likosky D.S.
        • Russell M.T.
        • et al.
        A regional registry for quality assurance and improvement: the vascular study Group of Northern new England (VSGNNE).
        J Vasc Surg. 2007; 46: 1093-1102.e1
        • Mehta M.
        • Darling R.C.
        • Roddy S.P.
        • et al.
        Factors associated with abdominal compartment syndrome complicating endovascular repair of ruptured abdominal aortic aneurysms.
        J Vasc Surg. 2005; 42: 1047-1051
        • Mayer D.
        • Pfammatter T.
        • Rancic Z.
        • et al.
        10 years of emergency endovascular aneurysm repair for ruptured abdominal aortoiliac aneurysms: lessons learned.
        Ann Surg. 2009; 249 (Available from:)
        • Hörer T.
        • Skoog P.
        • Pirouzram A.
        • et al.
        Tissue Plasminogen Activator–Assisted hematoma evacuation to relieve abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm.
        J Endovasc Ther. 2012; 19: 144-148
        • Ersryd S.
        • Djavani Gidlund K.
        • Wanhainen A.
        • et al.
        Editor’s Choice – abdominal compartment syndrome after surgery for abdominal aortic aneurysm: subgroups, risk factors, and outcome.
        Eur J Vasc Endovasc Surg. 2019; 58: 671-679
        • Raeburn C.D.
        • Moore E.E.
        • Biffl W.L.
        • et al.
        The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery.
        Am J Surg. 2001; 182: 542-546
        • Rubenstein C.
        • Bietz G.
        • Davenport D.L.
        • et al.
        Abdominal compartment syndrome associated with endovascular and open repair of ruptured abdominal aortic aneurysms.
        J Vasc Surg. 2015; 61: 648-654