Multiple Organ Failure, High Mortality After Ruptured Abdominal Aortic Aneurysm Repair

Multiple organ failure (MOF) occurs in 9% to 14% of patients after repair of a ruptured abdominal aortic aneurysm (rAAA) and is associated with a 3-fold increase in mortality, researchers reported in the Journal of Vascular Surgery.

The retrospective cohort study included patients with rAAA who received repair at a multihospital integrated regional health care system from 2010 to 2020.

MOF was defined with use of 3 scoring systems: the Denver score, the Sequential Organ Assessment Score (SOFA), and the Marshall Multiple Organ Dysfunction Score (MODS) score. The Denver criteria defined MOF as a score of higher than 3. The SOFA criteria defined MOF as dysfunction in 2 or more organs on a given day. The MODS criteria defined MOF as a score of 8 or higher.

The primary outcome was 30-day mortality.

Among 370 patients with rAAA who received repair, 288 (median age, 72.0; 76.7% men) survived past 2 days. For postoperative days 3 to 5, 14.24% of participants had MOF with the Denver criteria, 9.03% with the SOFA criteria, and 13.54% with the MODS criteria. For MOF with use of any scoring method, 19.4% of patients met the criteria. Patients with MOF were more likely to have had a previous stroke (17.9% MOF+ vs 6.0% MOF-, P =.016).

Pulmonary derangement occurred in 65.9% (Denver), 57.7% (SOFA), and 56.4% (MODS) among patients with MOF. In addition, neurologic derangement was observed in 92.3% (SOFA) and 89.7% (MODS) of patients with MOF, and renal derangement occurred in 26.8% (Denver), 23.1% (SOFA), and 10.3% (MODS) of  patients with MOF.

The 30-day mortality was 16.0% in the 288 patients in the primary cohort and 34.6% in the full cohort of 370 patients. Having MOF for all 3 scoring systems was associated with increased 30-day mortality (11.3% vs 41.5%; P <.01 [Denver]; 12.6% vs 46.2%; P <.01 [SOFA];12.5% vs 35.9%; P <.01 [MODS]), as was having MOF using any criteria (10.8% vs 35.7%, P <.01), in unadjusted Kaplan-Meier survival curves. MOF continued to be an independent predictor of 30-day mortality in the multivariate analysis (odds ratio [OR], 3.42; 95% CI, 1.47-7.96; P =.004).

Chronic kidney disease was associated with an increased incidence of MOF (OR, 2.45; 95% CI, 1.06-5.67; P =.037), and endovascular repair was protective against MOF (OR, 0.19; 95% CI, 0.09-0.39, P <.001) in the logistic regression model.

Nonsurvivors were significantly older vs survivors (82.0 years vs 70.0 years; P <.001).

Limitations of the study include the retrospective design and inability to account for residual confounding and variations in clinical data collection. Also, the number of patients included in the analysis is limited owing to the rare nature of the pathology and decreasing incidence.

“MOF develops in a subset of patients after successful rAAA repair and is associated with considerable short-term mortality,” wrote the study authors. “Endovascular repair may benefit against the high mortality associated with this syndrome. Further prospective efforts with more robust data and follow-up are necessary to truly understand MOF’s natural history and identify potential intervention targets.”