Survival after ruptured abdominal aortic aneurysm: effect of patient, surgeon, and hospital factors

Abstract

For elective AAA repair, and even more so for ruptured AAA repair, high-volume surgeons with subspecialty training conferred a significant survival benefit for patients. Although this would seem to argue in favor of regionalization, decisions should await a more complete understanding of the relationship between transfer time, delay in treatment, and outcome.

Meta-analysis and systematic review of the relationship between volume and outcome in abdominal aortic aneurysm surgery

“…Four articles (31,58,61,62) found a significant volume-outcome relationship favouring higher-volume hospitals, and three (20,56,60) found no association between volume and outcome, but did not reach statistical significance. …”

“…A further 11 articles (68 411 patients) were assessed in a systematic review (Appendix 3: available as supplementary material online at www.bjs.co.uk) (19,20,21,32,47,56,58,59,60,61,62) , of which six (19, 32, 47, 58, 59, 61) presented strong evidence for improved results at higher-volume hospitals, four (20,21,56,60) found no association between volume and outcome, and one (62) reported significant results favouring surgery at lowervolume hospitals.…”

Endovascular Aortic Aneurysm Repair in Patients With the Highest Risk and In-Hospital Mortality in the United States

“…Based on 15 diagnosis codes (ICD-9-CM) and the clinical classification software (Agency for Healthcare Research and Quality, Rockville, Md) coding system included in the data, which limits and prevents overcoding, 9 we calculated a comorbidity index using a modified Charlson comorbidity index (CCI), 10 a validated measure for use with administrative data that correlates with inhospital morbidity and mortality after surgical procedures, including elective AAA repairs. 11 Each of the indicated diagnoses is assigned a weight and summed to provide a patient's total score. The ability of the CCI to predict in-hospital mortality was initially assessed.…”

Prognostic factors associated with mortality in patients undergoing emergency surgery for abdominal aortic aneurysms

“…The individual institutional mortality rate for ruptured AAAs can vary, possibly depending upon referral pattern and specialization of the hospital. A large number of attempts have been made to clarify specific risk profiles and to infer predictive factors attributable to postoperative death in surgical patients with ruptured AAAs [11][12][13][14][15][16][17][18][19][20][21]. The aim of this retrospective study was to identify prognostic, preoperative, and intraoperative factors influencing mortality in patients undergoing emergency surgery for ruptured or imminent rupture of AAAs.…”