Usefulness of the Hardman index in predicting outcome after endovascular repair of ruptured abdominal aortic aneurysms

Objectives: The Hardman index, which has five variables, has been recommended as a predictor of outcome after open repair of ruptured abdominal aortic aneurysms (RAAAs). It has been reported that the presence of three or more variables is uniformly fatal. The aim of this study was to test the same model in an independent series of RAAA patients undergoing endovascular repair. Methods: A consecutive series of 41 patients undergoing endovascular repair for RAAA during all 8-year period was analyzed retrospectively. Thirty-day mortality and patient variables, including the five Hardman risk factors of age >76 years, serum creatinine > 190 mu mol/L, hemoglobin < 9 g/dL, loss of consciousness, and electrocardiographic (ECG) evidence of ischemia, were recorded. The Hardman index and a revised version of the index with four variables without ECG ischemia) were calculated and related to clinical outcome. Results: Operative mortality was 41% (17 of 41). On univariate analysis, only age >76 years (P = .01) and the use of local anesthesia (P < .0001) were statistically significant. Loss of consciousness (P = .05) showed a trend toward a higher mortality, albeit not statistically significant. On multivariate analysis, the use of local anesthesia was the only significant predictor of survival (odds ratio [OR], 0.03; 95% corifidence interval [CI], 0.003-0.25, P = .001). Again, loss of consciousness showed an association with a higher chance of dying but did not achieve statistical significance (OR, 6.30; 95% CI, 0.93-42.51, P =.059). The original and revised versions of the Hardman index were both significantly associated with death (P = .02 and P = .001, chi(2) test for trend). The cumulative effect of 0, 1, 2, and :3 risk factors oil mortality was 0%, 27%, 36%, and 71% for the original index, and 12.5%, 21%, 60%, and 78% for the revised version, respectively. Four and two patients with a score of 3 in each version of the index survived endovascular repair. Conclusions: The Hardman index, with or without incorporating ECG ischemia, seems to be a simple and useful predictive tool in patients undergoing endovascular repair of RAAA, with the mortality rate increasing along with the Hardman score. However, the index cannot be used to accurately identify patients with no chance of survival after endovascular repair.