A new metric for centralization of ruptured abdominal aortic aneurysm repair in large territories

Nault, Patrice; Brisson-Tessier, Camille; Hamel, Denis; Lambert, Laurie; Blais, Claudia

doi:10.1016/j.jvs.2015.04.442

Cited by 15 publications

(12 citation statements)

References 26 publications

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“…Although there is no proven critical time limit for transfer, attempts should be made to consider a transport time of less than 1 hour when at all possible. A recent post hoc analysis of patients with ruptured aneurysms suggested that door-to-EVAR time of 90 minutes may result in improved survival 29 ; however, in some states, the legal burden of responsibility for a transferred patient is evenly divided between the sending and receiving hospitals. For this reason, we do not advocate for transfer without an accepting physician.…”

Section: Discussionmentioning

confidence: 99%

Western Vascular Society guidelines for transfer of patients with ruptured abdominal aortic aneurysm

Mell

Starnes

Kraiss

et al. 2017

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Western Vascular Society guidelines for transfer of patients with ruptured abdominal aortic aneurysm

Mell

Starnes

Kraiss

et al. 2017

Journal of Vascular Surgery

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“…Još uvek nema dovoljno istraživanja koja su se bavila poređenjem preživljavanja bolesnika u kontekstu dužine transporta u adekvatnu zdravstvenu ustanovu [41,42] tako da je ovaj vremenski algoritam formiran na osnovu vodiča American College of Cardiology (ACC) Foundation/American Heart Association (AHA) u tretmanu infarkta miokarda sa ST elevacijom (STEMI) [43]. Celokupni period transporta je podeljen na tri dela po principu 30-30-30 minuta.…”

Section: Osnovni Principi Reanimacije I Tretmana Tokom Prvog Kontaktaunclassified

The emergency medical team's role in initial treatment and transport of patients with abdominal aortic aneurysm rupture

Crnokrak¹,

Čolaković²,

Zdravkovic³

et al. 2019

NČ urgent medic Halo 194

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“…They highlight the Amsterdam Acute Aneurysm (AJAX) trial, a randomized controlled trial (RCT), as a credible reference showing no mortality difference. 1…”

Section: Replymentioning

confidence: 99%

Regarding “A new metric for centralization of ruptured abdominal aortic aneurysm repair in large territories”

Broek

Vos

2016

Journal of Vascular Surgery

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With great interest we read the article on the method to measure the door-to-door time as a metric for ruptured abdominal aneurysms. 1 This article described 2 remarkable observations, the first one being the introduction of door-to-door time as a quality parameter, the second being the absence of difference in mortality between low-and high-volume hospitals.One of the cornerstones of their argument for centralization is the suggestion that by using endovascular aneurysm repair (EVAR), the mortality of ruptured abdominal aneurysms can be reduced. As an argument for this hypothesis the authors present their own data, where the 6.3% of patients with EVAR had a mortality of almost 18%, whereas the remaining group of open patients had a mortality of >35%.Clearly these retrospective data do not support this thesis. On the contrary, the variation in volume of patients according to center suggests that the EVAR group is highly selected, specifically that there might exist a bias in which EVAR is only undertaken for less complicated cases. Although there is some potentially biased evidence that EVAR offers a mortality benefit over open repair, there are also randomized controlled trials that did not show any statistical difference in mortality between EVAR and open repair. 2 Because of such inherent potential bias in the registry presented, this study provides insufficient data to support the authors' conclusion of improved survival after EVAR with centralization of repair.

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A new metric for centralization of ruptured abdominal aortic aneurysm repair in large territories

Abstract: DEDE 90 is a new metric for a coherent centralization model, particularly in large territories, where transport time is crucial. Increasing access to EVAR performed in high-volume centers, with consideration to transport time, could improve the 30-day mortality after a RAAA repair.

Cited by 15 publications

References 26 publications

Western Vascular Society guidelines for transfer of patients with ruptured abdominal aortic aneurysm

Western Vascular Society guidelines for transfer of patients with ruptured abdominal aortic aneurysm

The emergency medical team's role in initial treatment and transport of patients with abdominal aortic aneurysm rupture

Regarding “A new metric for centralization of ruptured abdominal aortic aneurysm repair in large territories”

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