BACKGROUND: Aortic reconstruction surgery for aneurysmal and occlusive disease is associated with significant morbidity and mortality. OBJECTIVES: To determine what variables influence patients' outcomes after elective aortic reconstruction surgery so that an evidence-based best-practice initiative can be developed for these patients. METHODS: A descriptive, comparative study of all patients undergoing elective aortic reconstruction from October 1997 through December 1998 was used. Retrospective chart review was used to collect demographic and clinical data on the first 48 subjects, who had been discharged from the hospital. Data on the other 63 subjects were collected prospectively. RESULTS: The typical subject was a 65-year-old man with a history of cardiovascular disease, hypertension, and smoking. Subjects were grouped by type of surgery and by outcome (survived without complications vs died or survived with major complications). Outcomes were not significantly different in patients undergoing different types of surgery. Variables associated with poor outcomes included history of cardiovascular disease, elevated preoperative levels of serum urea nitrogen and creatinine, high volumes of salvaged autologous blood administered intraoperatively, and early postoperative hypotension that required treatment. Pulmonary complications were the most common; next most common were cardiac complications. History of cardiovascular disease and hypotension were significant predictors of outcome. CONCLUSION: The variables associated with poor outcomes can be used to design a best-practice initiative for patients undergoing elective aortic reconstruction.