Association of hospital structures with mortality from ruptured abdominal aortic aneurysm

Abstract

The variability in rAAA outcome in English National Health Service hospital Trusts is associated with modifiable hospital resources. Such information should be used to inform any proposed quality improvement programme surrounding rAAA.

Low Level of Antithrombin Iii as a Warning Sign for Developing Thrombotic Complications in Surgical Patients

“…Univariate analysis showed a connection between nosocomial episodes of thrombosis and the following factors: emergency surgery (OR 9.1, p<0.01), peripheral vessel disease (OR 13.5, p=0.01), collapse development in pre-operation period (OR 30, p<0.01), high content of D-dimers (OR 30, p<0.01) and low content of AT III (OR 13.5, p=0.01). Moreover, it is well-known that emergency operations and peripheral vascular disease [9][10][11] are associated with an increased operative risk [12][13][14][15] although the amount of risk involved as reported in the literature varies.…”

Procedure Volume and the Association with Short-term Mortality Following Abdominal Aortic Aneurysm Repair in European Populations: A Systematic Review

“…Of a total of 17 284 citations, 16 studies [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] (237 074 patients) were eligible for inclusion in this review of the volume outcome relationship in patients undergoing AAA repair. A summary of the study selection is shown in the PRISMA flow chart (Figure 1).…”

“…16,29 , with numbers needed to treat as low as 13 for a comparison of outcomes between a low volume centre (1-3 procedures per year) and relatively high volume (8)(9)(10)(11)(12)(13)(14)(15) cases per year). Two studies 24,25 also include the numbers of admissions for non-corrective treatment in their analyses, either in the group in which volume is measured (C13) or in the group that outcome is measured (C14), both studies finding evidence of statistically significant effects of volume on mortality (in hospital and 90 day).…”

Ambulance smartphone tool for field triage of ruptured aortic aneurysms (FILTR): study protocol for a prospective observational validation of diagnostic accuracy

“…For patients with rAAA, many non-operative factors are key determinants of survival. 4 The lowest mortality for rAAA is seen in hospitals that have greater bed capacities, greater availability of support services, higher annual procedural caseload of AAA repair with a greater proportion of cases undergoing endovascular repair. 4 Data from a large prospective multicentre randomised clinical trial of different surgical techniques (IMPROVE) suggests that the type of surgery itself may not play as great a role in overall survival.…”

“…4 The lowest mortality for rAAA is seen in hospitals that have greater bed capacities, greater availability of support services, higher annual procedural caseload of AAA repair with a greater proportion of cases undergoing endovascular repair. 4 Data from a large prospective multicentre randomised clinical trial of different surgical techniques (IMPROVE) suggests that the type of surgery itself may not play as great a role in overall survival. 2 5 6 In-hospital survival from rAAA, intervention rates and uptake of endovascular repair are lower in England than in the USA, further suggesting there is room for improvement in the organisation and delivery of care.…”