Purpose Prediction of individual survival benefit from elective surgery for infrarenal abdominal aortic aneurysm (AAA) is dependent upon a complex interplay between several independent but inter‐related variables. A computerised evidence‐based predictive model was developed to assist clinical decisions on indications for, and timing of, AAA surgery.Methodology A systematic review of the literature was conducted to identify independent variables that determine survival of patients with AAA. A complex Markov‐type predictive model was developed with the following outputs: Predicted risk of rupture, operative mortality, life expectancy after AAA surgery, survival with/without surgery, survival curve crossover and breakeven points and number needed to treat.Results Independent determinants of survival identified included predictors of a) AAA rupture (Initial diameter; Annual growth rate; Sex; Mean BP; Smoking status), b) Operative mortality (Surgical unit average mortality; Age; Sex; Cardiac, renal and pulmonary co‐morbidity), c) Life expectancy (Median life expectancy at baseline; average annual mortality secondary to co‐morbidity; adjustment for smoking, CHF or ischaemic ECG, Renal
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