In-hospital mortality from abdominal aortic surgery in Great Britain and Ireland: Vascular Anaesthesia Society audit

Bayly, P. J. M.; Matthews, J. N. S.; Dobson, Paul D.; Price, Mary L.; Thomas, David G.

doi:10.1046/j.0007-1323.2001.01778.x

Cited by 90 publications

(71 citation statements)

References 22 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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“…Thirty-day mortality figures of up to 7.3% for elective infrarenal aortic aneurysm repair [1][2][3], 1.7% for endovascular aortic repair [4] and 6% for aortobifemoral surgery [5,6] are quoted in the literature. The mortality rate for carotid endarterectomy, although less than 2%, is predominantly due to myocardial infarction [7,8].…”

mentioning

confidence: 99%

The impact of a consultant anaesthetist led pre‐operative assessment clinic on patients undergoing major vascular surgery*

Cantlay¹,

Baker

Parry

et al. 2006

Anaesthesia

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Summary Patients undergoing major vascular surgery are at high risk of peri‐operative morbidity and mortality owing to a combination of advanced age, significant co‐morbidity and the nature of the surgery. A consultant‐led pre‐operative assessment clinic provides an opportunity to stratify these patients on the basis of risk in advance of surgery, to make timely multidisciplinary referrals where appropriate, and to prescribe medical therapies according to the current best evidence. This results in fewer last‐minute cancellations for medical reasons and increased patient satisfaction, and may improve patient outcome. Such a clinic also provides an educational arena for nursing and trainee medical staff, and importantly allows those patients in whom the risks are felt to outweigh the potential benefits of surgery to be managed in a more fully informed manner.

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“…Mortality rates of 5%-7% can be expected in OAS, most of it connected with CAD [1,2]. Recent development of EVAR has been postulated to likely increase the mortality rate in open surgery, since anatomically more complex aneurysms still require open repair.…”

Section: Discussionmentioning

confidence: 96%

No increase in mortality after open infrarenal aortic surgery in the era of evar

et al. 2011

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The mortality rate for elective infrarenal aortic surgery is on the order of 5%-7%. Most deaths are related to coronary heart disease (CAD). Significant coronary heart disease is present in some 60% of patients who need elective aortic operations. Risk-stratification scales are not particularly helpful in finding CAD. It is generally assumed that since the more straightforward cases are managed by endoprosthesis, the mortality rate related to open repair may be on the rise. We report 218 consecutive elective infrarenal aortic operations performed at the Swiss Cardiovascular Center (University Hospital, Berne) between 1998 and 2001. There were 36 (17%) females and 182 (83%) males, mean age 66.7 years (range 42-86 years). Of the patients, 87 (40%) were older than 70, 35 (16%) older than 75 years of age. A prior myocardial infarction was diagnosed in 42 (19%), 141 (65%) were hypertensive, 20 (9%) had diabetes mellitus (IDDM), 24 (11%) renal insufficiency (creatinin >13 mg/ dL) and 79 (36%) chronic obstructive pulmonary disease (COPD). The initial screening was done by an in-house internist. As a result, 179 patients (82%) underwent cardiological evaluation, which in turn led to 71 (33%) stress echocardiographies, and subsequently 47 (22%) coronary angiographies. This in turn led to coronary revascularization in 24 (11%). Five carotid endarterectomies (2.3%) were performed prior to planned aortic surgery. There was no mortality related to these operations. Aneurysm repair was performed in 165 (76%) patients, surgery for atherosclerotic lesions in 53 (24%). In-hospital mortality was 1 (0.5%). There was no further 30-day mortality. We conclude that the results of open infrarenal aortic surgery can be improved by active screening by an in-house internist and treatment of underlying vascular and lung disease. This should be reflected in reimbursement policies.

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In-hospital mortality from abdominal aortic surgery in Great Britain and Ireland: Vascular Anaesthesia Society audit

Abstract: Although the in-hospital mortality rate was similar to previously published figures, the rate increased considerably when commonly encountered risk factors were present.

Cited by 90 publications

References 22 publications

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

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

The impact of a consultant anaesthetist led pre‐operative assessment clinic on patients undergoing major vascular surgery*

No increase in mortality after open infrarenal aortic surgery in the era of evar

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