A 21-year experience of abdominal aortic aneurysm operations in Edinburgh

Bradbury, A. W.; Adam, D. J.; Makhdoomi, K. R.; Stuart, Wesley; Murie, J. A.; Jenkins, A. McL.; Ruckley, C. V.

doi:10.1046/j.1365-2168.1998.00695.x

Cited by 63 publications

(54 citation statements)

References 12 publications

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“…The findings of this single centre study are consistent with published data describing the high-risk surgical population [1,[10][11][12][13][14][15][16][17][18][19][20][21][22]. The size and nature of the highrisk population in our institution is similar to that identified in the national UK study and although it might appear that a greater proportion of high-risk surgical patients are admitted to a critical care area in our Trust, this observation may also be explained by an underestimate of critical care admissions in the national study [1].…”

Section: ó 2008 the Authorssupporting

confidence: 82%

Mortality and utilisation of critical care resources amongst high‐risk surgical patients in a large NHS trust*

Jhanji¹,

et al. 2008

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SummaryPrevious reports describe a population of non-cardiac surgical patients at high risk of complications and death. Outcomes are sub-optimal for such patients, perhaps in part related to inadequate provision or ineffective utilisation of critical care resources. In this study, data describing 26 051 in-patient non-cardiac surgical procedures performed in a large NHS Trust between April 2002 and March 2005 were extracted from local databases. Of these procedures, 2 414 (9.3%) were high risk with an overall mortality rate of 12.2% and a prolonged hospital stay (high-risk population median (IQR) 16 (9-30) days vs standard risk 3 (2-6) days). Mortality rates for specific procedures were consistent with UK averages. However, only 852 (35.3%) high-risk patients were admitted to a critical care unit at any stage after surgery. Of 294 high-risk patients who died, only 144 (49.0%) were admitted to a critical care unit at any time and only 75 (25.6%) of these deaths occurred within a critical care area. Mortality rates were high amongst patients discharged and readmitted to critical care (37.7%) and amongst those admitted to critical care following initial postoperative care on a standard ward (29.9%). These data suggest that the outcome of high-risk general surgical patients could be improved by adequate provision and more effective utilisation of critical care resources.

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Section: ó 2008 the Authorssupporting

confidence: 82%

Mortality and utilisation of critical care resources amongst high‐risk surgical patients in a large NHS trust*

Jhanji¹,

et al. 2008

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“…The requirement for aortic anatomy amenable to either open or endovascular repair can also potentially improve outcomes in both treatment arms, as mortality rates were generally lower in the randomized trials than in retrospective cohort studies (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Study limitations.…”

Section: Discussionmentioning

confidence: 98%

“…Given its long-term durability, open repair has traditionally been offered to patients with a moderate life expectancy. The major disadvantage of open repair has been an associated 30-day mortality rate of 4% to 5% and even up to 8.2% in some series (2)(3)(4). Advanced age, cardiovascular disease, and other major medical comorbidities may place certain patients with AAA at prohibitive operative risk (1).…”

mentioning

confidence: 98%

Open Versus Endovascular Stent Graft Repair of Abdominal Aortic Aneurysms

Dangas

O’Connor

Firwana

et al. 2012

JACC: Cardiovascular Interventions

101

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In patients randomized to open or endovascular AAA repair, all-cause perioperative mortality, as well as AAA-related mortality at short- and intermediate-term follow-up are lower in patients undergoing endovascular stent graft placement. This was associated with greater reintervention in the endovascular group noted at intermediate follow-up. Long-term survival appears to converge between the 2 groups.

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“…[1][2][3][4][5][6][7] Elective open surgical repair of infrarenal abdominal aortic aneurysm (AAA) is associated with an operative mortality rate of 3% to 10%. [8][9][10][11][12] Ischemia reperfusion injury results in a systemic inflammatory response with microvascular and macrovascular thrombosis that may cause myocardial injury, thromboembolism, and multiple organ failure thereby accounting for the great majority of operative mortality. 13,14 By contrast, endovascular aneurysm repair (EVAR) of an AAA avoids much of this physiological disturbance and by so doing offers a safer alternative in anatomically suitable patients.…”

mentioning

confidence: 99%