The Glasgow Aneurysm Score does not predict mortality after open abdominal aortic aneurysm in the era of endovascular aneurysm repair

• Published in: Journal of vascular surgery 2011-08, Vol.54 (2), p.353-357
• Main Authors: Patterson, Benjamin Oliver, BSc, MRCS, Karthikesalingam, Alan, MA, MRCS, Hinchliffe, Robert J., MD, MRCS, Loftus, Ian M., MD, FRCS, Thompson, Matt M., MD, FRCS, Holt, Peter J.E., PhD, FRCS
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - diagnosis; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Chi-Square Distribution; Diseases of the aorta; Endovascular Procedures - mortality; Female; Health Status Indicators; Humans; Male; Medical sciences; Middle Aged; Predictive Value of Tests; Reproducibility of Results; Risk Assessment; Risk Factors; ROC Curve; Severity of Illness Index; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Treatment Outcome; United Kingdom - epidemiology; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures - mortality
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2011.01.029

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 χ2 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.