Predictors of Discharge Disposition Following Repair of Blunt Thoracic Aortic Traumatic Injuries

Abstract

The province of Saskatchewan presents unique challenges for ruptured abdominal aortic aneurysms (AAAs), including variable access to health care resources and large transportation distances to tertiary vascular care. The goal of this study was to assess the rates of ruptured and unruptured aneurysms to determine whether there are areas of high aneurysm incidence that would benefit from further study and the possible implementation of a targeted screening protocol to improve management and prevention of aneurysm rupture. Methods: All diagnoses of AAA from 2001 to 2011 in the province of Saskatchewan were reviewed, with patients grouped by health region of residence. Diagnoses of ruptured and unruptured AAA were obtained from the Saskatchewan Discharge Abstract Database, Medical Services Billings Claims data, and Vitals Stats data. International Classification of Diseases, 9th Revision and 10th Revision, codes were used to identify specific patients with the diagnosis of AAA. Results: A total of 6163 AAAs were diagnosed, and 1667 AAAs were repaired over the study period. Mean age at diagnosis was 71.7 years, with 68% of all aneurysm diagnoses in men. Only 2% of patients were aboriginal. The provincial age-adjusted rate of AAA was 54.5 per 100,000 (95% confidence interval [CI], 53.18-55.91). The highest age-adjusted rate of AAA was found in the Five Hills Health Region (FHHR; 63.1 per 100,000; 95% CI, 57.63-69.03), which was significantly higher than the provincial average (P < .05). The rate of ruptured aneurysms in FHHR was nearly twofold higher than the provincial average (65.8 vs 32.1 per 100,000, respectively). The lowest aneurysm rates were found in the north of the province (age-adjusted rate, 44.6 per 100,000; 95% CI, 34.17-57.32). Conclusions: There are significant geographical variations in the incidence of ruptured and unruptured AAA in the province of Saskatchewan, with the highest incidence of unruptured and ruptured aneurysms localized to the FHHR. Why there is a preponderance of aneurysms in this area is unclear, but it suggests targeted screening may help reduce the number of aneurysms treated emergently for rupture.