This thesis aims to examine the validity of existing tools recommended for outcome prediction
after abdominal aortic aneurysm (AAA) rupture and to design and validate a novel risk scoring
instrument. It also aims to examine the utility of novel predictive variables. Finally, it examines
the functional outcomes achieved by survivors of aneurysm rupture.
Existing risk models and predictive variables for outcome were validated on a retrospective
cohort of consecutive patients with ruptured AAA. These data were also used to design a novel
prognostic index for outcome prediction. A prospective cohort of consecutive patients was used
to further validate these scoring systems, examine novel prognostic variables and determine
Existing risk scoring instruments for patients with ruptured AAA lack validity. Analysis of
preoperative variables in patients with ruptured AAA shows that absolute surgical futility cannot
be predicted. However, in-hospital hypotension (<90mmHg), reduced Glasgow Coma Scale (<15)
and anaemia (<9g/dL) are associated with perioperative death. When these risk factors are equally
weighted and combined to create a novel risk scoring instrument (Edinburgh Ruptured Aneurysm
Score-ERAS), three discriminatory tiers of risk are demonstrable. The validity of this risk
instrument is confirmed on prospective data. Examination of novel perioperative prognostic
variables shows that elevated cardiac troponin I, with or without clinically apparent cardiac
dysfunction, is predictive of death after ruptured AAA repair. However, although ruptured AAA
are associated with an early elevation in inflammatory biomarkers, these do not appear to confer
additional prognostic value. Furthermore, for the first time, prospective study shows that patients
who survive ruptured AAA repair achieve a good recovery in terms of functional outcome within
six months of operation.
Surgical futility cannot be predicted prior to operation in patients with AAA. However, the ERAS
shows potential as a preoperative prognostic index in patients with ruptured AAA.