Advantage of a one-stop referral and management service for ruptured abdominal aortic aneurysms

Abstract

Patients with RAAA should be offered a one-stop emergency vascular service even if this involves further travel. Such a strategy offers significantly higher chance of intervention and survival from ruptured AAA.

Epidemiology of ruptured abdominal aortic aneurysms in a well-defined Norwegian population with trends in incidence, intervention rate, and mortality

“…Perioperative mortality is invariably higher (>40%) when nonintervention rates are reported. 15,16,19 In our series, the operative mortality was 51%. One may speculate that there is an inverse relationship between low nonintervention rates and high perioperative mortality.…”

“…Notably, most previous studies report a substantially higher nonintervention rate. 15,16 Lower nonintervention rates are rarely reported, with only two previous studies reporting numbers below 20% (19% and 9%, respectively), 18,19 and neither of these studies published the clinical or forensic autopsy rates in the relevant catchment areas. In our study, a substantial portion of the "nonintervention" patients were diagnosed post mortem (n ¼ 12) or were moribund or agonal (n ¼ 14) at the time of diagnosis.…”

“…However, the service provided is devoid of referral bias and diagnostic delay, as the hospital covers all patients in the region for a centralized, one-stop, protocol-committed care for all vascular emergencies. 16,17 Altogether, 27% (52 of 196) of the patients who were admitted to the hospital did not have an intervention. Notably, most previous studies report a substantially higher nonintervention rate.…”

Abdominal Aortic Aneurysm : Aspects on how to affect mortality from rupture

“…the patient is treated at the hospital were he primarily seeks medical care, even if this involves further travel, compared to a two---stop referral pattern, i.e. being transported from the hospital were the patient seeks primary care, to a hospital performing surgery for AAA (Hafez et al 2009). …”

“…For AAA ≥ 55 recent data suggested an annual risk of approximately 25% (Noronen et al 2013). According to a recent review (Reimerink et al 2013b), two studies reported the proportion of patients reaching surgery if rupture occurs (Acosta et al 2006, Hafez et al 2009). Synthesising data from these two studies yielded an estimated probability of reaching surgery of 39%.…”