A review of the literature shows a very variable mortality, especially after emergency operations for abdominal aortic aneurysm (AAA) (14-70%). We therefore analyzed the mortality of our patients in different subgroups. The hospital data of 82 patients operated on for abdominal aortic aneurysm were analyzed retrospectively. 42 patients underwent emergency operations and 40 patients elective surgery. The mean age was 67.5+/-9.4 and 70.7+/-7.3 years respectively. The overall 30-day mortality in elective cases was 5% (2/40); elective patients under the age of 75 years had a mortality of 0%. 33% of the emergency cases died within 30 days. The mortality in various subgroups was as follows: "asymptomatic AAA" 5.4% (2/37), "symptomatic AAA" 10% (1/10), "retroperitoneal rupture" 34% (11/32) and "intraperitoneal rupture" 66.6% (2/3). Preoperatively 21/42 patients who underwent emergency surgery were in hypovolemic shock (systolic blood pressure less-than-or-equal-to 90 mm Hg). The mortality of these patients was 52% (11/21) compared to 9.5% (2/21), (p <0.01), in emergency patients without preoperative shock. The causes of death after emergency procedures were hypovolemic shock in 6, heart failure in 4, and multi-organ failure, respiratory insufficiency, unknown and pulmonary embolism in 1 each. 5/14 patients died in theatre. Two patients died after elective procedures: one 9 days postoperatively from myocardial infarction and the second 23 days after the operation from an unknown cause. Reoperation rate after elective and emergency procedures was 7.5% and 16.6% respectively. Mortality after reoperation was 40%. The reasons for reoperation were bleeding in 6, ischemia of the left colon in 2, embolism of the lower extremities in 2 and graft occlusion in 1. The analysis of different subgroups shows increasing mortality from symptomatic AAA to retroperitoneally ruptured AAA and then to intraperitoneally ruptured AAA. Depending on the relative percentage of each group in a population the overall mortality, especially for emergency procedures, can vary considerably. Preoperative hypovolemic shock and reoperation for complications show a high mortality. But elective operation for AAA in patients under the age of 75 years carries a very low risk.
