Association of Operative Repair Type and Trauma Center Designation With Outcomes in Ruptured Abdominal Aortic Aneurysm Repair

Abstract

Objective: Open repair of ruptured abdominal aortic aneurysm (rAAA) has shown improved outcomes at trauma centers. Whether the benefit of trauma center designation extends to endovascular repair of rAAA is unknown. Methods: Retrospective cohort study using the California Office of Statewide Health Planning and Development 2007 to 2014 discharge database to identify patients with rAAA. Data included demographic and admission factors, discharge disposition, International Classification of Diseases, Ninth Revision, Clinical Modification codes, and hospital characteristics. Hospitals were categorized by trauma center designation and teaching hospital status. The effect of repair type and trauma center designation (level I, level II, or other—other trauma centers and nondesignated hospitals) was evaluated to determine rates and risks of 9 postoperative complications, in-hospital mortality, and 30-day postdischarge mortality. Results: Of 1941 rAAA repair patients, 61.2% had open and 37.8% had endovascular; 1.0% had both. Endovascular repair increased over the study interval. Hospitals were 12.0% level I, 25.0% level II, and 63.0% other. A total of 48.7% of hospitals were teaching hospitals (level I, 100%; level II, 42.2%; and other, 41.8%). Endovascular repair was significantly more common at teaching hospitals (41.5% vs 34.3%, P < .001) and was the primary repair method at level I trauma centers ( P < .001). Compared with open repair, endovascular repair was protective for most complications and in-hospital mortality. The risk for in-hospital mortality was highest among endovascular patients at level II trauma centers (hazard ratio 1.67, 95% confidence interval [CI]: 0.95-2.92) and other hospitals (hazard ratio 1.66, 95% CI: 1.01-2.72). Conclusions: Endovascular repair overall was associated with a lower risk of adverse outcomes. Endovascular repair at level I trauma centers had a lower risk of in-hospital mortality which may be a result of their teaching hospital status, organizational structure, and other factors. The weight of the contributions of such factors warrants further study.

Observation on the Efficacy of Autologous Blood Transfusion Combined with Controlled Hypotension in Patients with Spinal Internal Fixation during the Outbreak of New Coronavirus Pneumonia in Western Guangxi (in Guixi)

“…Beginning in the 1970s, the construction of trauma centers in developed countries has replaced the three-peak model by the single-peak model [1]. According to the fifth general survey of health services in China, about 700,000 people die from trauma every year, ranking the fifth of the total cause of death [2]. Trauma will cause great pain and casualties in a very short period of time, and the losses caused by subsequent injuries and disabilities are more serious.…”

“…Trauma will cause great pain and casualties in a very short period of time, and the losses caused by subsequent injuries and disabilities are more serious. The annual medical expenses caused by trauma in China are as high as 65 billion yuan [2] [3]. In my country, according to statistics, the amount of clinical blood used is increasing at a rate of 10% per year.…”

Does the ‘halo effect’ of trauma center verification extend to severe postpartum hemorrhage? A four-year retrospective review of level 1 trauma centers in the United States

“…5–8 This so-called ‘halo effect’ is, however, not generally present for all patients or diseases. For instance, it has been shown to extend to patients with ruptured abdominal aortic aneurysms (AAA), 9,10 and to emergency general surgery (EGS) cases, 7 but not to emergent colectomies 8 or to non-surgical patients. 11 This variability in the halo effect cannot be easily explained, given differences in the study designs and patient populations, and motivates inquiry based on specific disease processes.…”