Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000–2015)

Abstract

WHAT THIS PAPER ADDSThe overall mortality of ruptured abdominal aortic aneurysm (rAAA) depends both on disease prevalence and mortality before and after hospital admission. In this article, the mortality related to rAAA was studied in Portugal based on national registries. Admission, repair, and mortality due to rAAA seem to have reached a peak and recently have been decreasing (2010e2015). At the same time, there was a gradual increased adoption of endovascular repair for ruptures. Mortality outside the hospital remains a matter of concern, warranting further planning of streamlined transfer networks and vascular surgical departments.Objective: Ruptured abdominal aortic aneurysm (rAAA) is a lethal condition that requires acute repair to prevent death. This analysis aims to assess the nationwide trends in rAAA admission, repair and mortality in a country, Portugal, without national screening for AAA. Methods: rAAA registered in the hospital administrative database of the National Health Service and all nationally registered deaths due to rAAA based on death certificate data were analysed. Three time periods (2000e2004, 2005e2009, and 2010e2015) were compared in patients ! 50 years old to assess the variations over time. Results: A total of 2 275 patients !50 years old with rAAA were identified in the two databases from 2000 to 2015. The age standardised incidence of rAAA was 2.78 AE 0.24/100 000/year in 2000e2004, 3.17 AE 0.39/100 000/year in 2005e2009 and 3.21 AE 0.28/100 000/year in 2010e2015 (p < .001). When comparing the time periods 2000e2004 to 2005e2009, the age standardised rate of admission (n ¼ 1460) increased from 1.57 AE 0.25/100 000/year to 2.24 AE 0.32/100 000/year (p < .001). The operative mortality rates decreased during this time period (from 55.3 AE 4.7% to 48.8 AE 4.7%, p < .001). In 2010e2015, the age standardised rate of admissions due to rAAA decreased (1.98 AE 0.22/100 000/year). Operative mortality remained stable (48.9 AE 6.2%). The rate of patient deaths outside the hospital decreased from the first to the second period (1.21 AE 0.10/100 000/year and 0.93 AE 0.29/100 000/year, respectively) but later increased (1.14 AE 0.22/100 000/year). This resulted in a higher overall rAAA related mortality in Portugal in the third period (2.20 AE 0.18/100 000/year, 2.21 AE 0.27/100 000/year and 2.26 AE 0.26/100 000/year in 2000e2004, 2005e2009, and 2010e2015, respectively, p < .001). Conclusion: Overall, the incidence of rAAA in Portugal has been stable over the past 10 years. The rates of admission, repair, and death due to rAAA repair seem to have reached an inflection point and are now decreasing. Mortality outside the hospital remains a matter of concern, warranting further planning of streamlined transfer networks and vascular surgical departments.

Epidemiology of Abdominal Aortic Aneurysm Repair in Brazil from 2008 to 2019 and Comprehensive Review of Nationwide Statistics Across the World

“…The increasing predominance of EVAR in Brazilian public hospitals agrees with observations in Portugal [22, 23], England [17], USA [13, 15, 24, 25] and South Korea [18]. Concerning rAAA repair, EVAR predominance is milder but still present.…”

Successful short interval staged surgery in synchronous type A aortic dissection and giant abdominal aortic aneurysm patient

“…We finally chose to treat the TAD first for the following reasons: 1) TAD is more likely to rupture. 2) An elephant trunk will make the second surgery much more manageable [ 5 ].…”

Screening for Abdominal Aortic Aneurysms and Risk Factors in 65-Year-Old Men in Oslo, Norway

“…A nationwide analysis of rAAA in Portugal has shown that approximately 75% of patients with rAAA die before reaching hospital or during hospitalization. 1 Budtz-Lilly et al have reported a perioperative mortality for emergency surgery at 28.8%. 2 Furthermore, the 30-day mortality ranges from around 30-60%.…”

“…2 Furthermore, the 30-day mortality ranges from around 30-60%. 1,[3][4][5] In contrast, mortality rates for elective AAA surgery are drastically lower, 30-day mortality range from 0.5% to 5.0%. [6][7][8][9] Several large studies have shown that one-time ultrasound screening in men above 65 years reduces the incidence of sudden AAA ruptures and aneurysm-related mortality.…”

“… 2 Furthermore, the 30-day mortality ranges from around 30–60%. 1 , 3–5 In contrast, mortality rates for elective AAA surgery are drastically lower, 30-day mortality range from 0.5% to 5.0%. 6–9 …”