Abstract
Comment: This thorough and cogent study is the largest reported series of AAA operations in the literature. It is a population-based study, looking at all hospital admissions with the diagnosis of AAA who underwent repair from 1980 to 1990 in Michigan. In-hospital mortality rates are studied, instead of the conventional 30-day postoperative mortality rates commonly seen in surgical journals. The results of this study show an improvement in mortality for elective AAA repair over the 10-yr period from 13.6% in 1980 to 5.6% in 1990. No change was seen in the 50% mortality rate after repair of ruptured AAA. The presence of ischemic heart disease was associated with higher surgical mortality rates from 1980 to 1983, but not afterward. The authors explore many possibilities for their results, including greater attention to cardiac risk factors for myocardial infarction, resulting in preoperative intervention (coronary artery bypass graft or percutaneous transluminal coronary angioplasty), as well as improved monitoring and intraoperative management of the patient with ischemic heart disease.
Published Version
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