Open Aortic Aneurysm Repair Mortality Risk Index
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Estimates 30-day mortality after elective open repair of an infrarenal abdominal aortic aneurysm.
Who this applies to, and differences from the paper's table and the original spreadsheet
The study left out ruptured aneurysms and patients who also had visceral-renal bypass or suprarenal aortic surgery.
This page uses the risk index published in 2013. The original spreadsheet, posted in September 2012, is an earlier model from the manuscript as first submitted. It uses hemiplegia and functional status and does not use sex or platelets, so it gives different numbers. It is no longer offered.
Risks here come from the formula in the paper's Methods: the logit is −4.981 + 0.3 × total points. The paper prints the intercept without its minus sign. This formula gives the printed Table IV except in two places:
- For 17 to 20 points, Table IV prints 47.03%, 39.68%, 32.76% and 26.52%. These are 100% minus the risk, so risk seems to fall as points rise. This page shows 52.97%, 60.32%, 67.24% and 73.48%.
- For 11 points, Table IV prints 15.4%. This page shows 15.70%.
About this model
- Built from 2,845 patients having elective open repair in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), 2007–2009.
- 30-day mortality was 3.3% (95 patients).
- C statistic 0.72. The Hosmer-Lemeshow test gave χ² 4.76, P = .57.
- Mortality seen in each risk group: 2.5% of 2,508 patients in the low group, 7.2% of 278 in the intermediate group, and 22.0% of 59 in the high group.
- The paper states that the index awaits validation in subsequent studies.
Points (Table III of the paper)
| Risk factor | Points |
|---|---|
| Dyspnea: none | 0 |
| Dyspnea: on moderate exertion | 2 |
| Dyspnea: at rest | 8 |
| Previous peripheral revascularization or amputation | 3 |
| Age: 65 years or younger | 0 |
| Age: over 65 years | 3 |
| Creatinine over 1.5 mg/dL | 2 |
| Abnormal platelets | 2 |
| Sex: male | 0 |
| Sex: female | 2 |
Risk by total points (Table IV of the paper, corrected as explained above)
No combination of answers gives 1 or 19 points.
| Total points | Estimated risk | Risk group |
|---|---|---|
| 0 | 0.68% | Low |
| 1 | 0.92% | Low |
| 2 | 1.24% | Low |
| 3 | 1.66% | Low |
| 4 | 2.23% | Low |
| 5 | 2.99% | Low |
| 6 | 3.99% | Low |
| 7 | 5.31% | Low |
| 8 | 7.04% | Intermediate |
| 9 | 9.27% | Intermediate |
| 10 | 12.12% | Intermediate |
| 11 | 15.70% | Intermediate |
| 12 | 20.08% | High |
| 13 | 25.33% | High |
| 14 | 31.41% | High |
| 15 | 38.20% | High |
| 16 | 45.49% | High |
| 17 | 52.97% | High |
| 18 | 60.32% | High |
| 19 | 67.24% | High |
| 20 | 73.48% | High |
Citation
Ramanan B, Gupta PK, Sundaram A, Gupta H, Johanning JM, Lynch TG, MacTaggart JN, Pipinos II. Development of a risk index for prediction of mortality after open aortic aneurysm repair. J Vasc Surg. 2013;58(4):871-8. doi:10.1016/j.jvs.2013.03.024 · PubMed 23676190
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