Scoring in endovascular and open repair of abdominal aortic aneurysms- Prospective Evaluation of the SVS/AAVS Comorbidity Severity Score compared to other risk scoring systems

Michael Gawenda, MD, Associate Professor¹, Sonja Schubert, CD¹, Gernot Wassmer, MD, PhD², Jan Brunkwall, MD, PhD¹.
¹Division of Vascular Surgery, Cologne, Germany, ²Institute of Medical Statistics and Epidemiology, Cologne, Germany.

Objectives: Decision making in AAA repair with either open (OR) or endovascular procedure (EVAR) is influenced by the course of disease and to the peri-operative mortality. Risk evaluation by scoring systems could be of value for the choice of the individual therapy. Aim of the presented study was to compare the value of the SVS/AAVS Comorbidity Severity Score (CSS) and two different preoperative risk scoring systems.
Methods: Between 2003 and 2005 the CSS was prospectively applied to 237 patients undergoing AAA repair, electively performed in 187 cases. Comparison was made to the ASA classification and the „Glasgow Aneurysm score” (GAS). The scorings were correlated to each other and to the mortality, the morbidity, and the length of postoperative hospital stay.
Results: Patients with electively performed OR (n=109) showed a CSS of 8.1±5.4, ASA-Score of 2.65±0.9, and GAS of 74.9±12.7. In elective EVAR (n=78) corresponding scorings were 10.3±5.3 (p<0.05), 2.6±0.9 (n.s.), and 79.4±11.3 (p<0.05). Patients with elective OR stayed significantly longer in the hospital (13.3±12.0 versus 8.3±5.0 days; p<0.05). Mortality was 2.8 percent (OR) and zero (EVAR) (n.s.). Morbidity rate (cardiac, pulmonary, and/or renal complications with therapeutic implications) was 10.1 percent (OR) and 9.0 percent (EVAR) (n.s.).
Conclusion: The newly developed Comorbidity Severity Score demonstrated the high risk profile of the EVAR patients with AAA as did the older scorings systems do. But there was no correlation demonstrable to mortality or morbidity.

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