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Kageyama S, Ohashi T, Kojima A, Kojima T. Emergency Open Surgical Repair for Ruptured Abdominal Aortic Aneurysm in Octogenarians and Nonagenarians: A Single-Center Retrospective Observational Study. Ann Vasc Surg 2024; 108:36-46. [PMID: 38942379 DOI: 10.1016/j.avsg.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/14/2024] [Accepted: 04/07/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND In the endovascular aneurysm repair era, open surgical repair (OSR) is performed for ruptured abdominal aorta aneurysm (RAAA) in patients with complex aneurysm neck and technical difficulties. Understanding the risk factors of OSR is essential for the clinical selection of the ideal surgical procedure. We aimed to re-evaluate the outcomes of OSR and treatment options for RAAA. METHODS Patients who underwent OSR for RAAA between January 2010 and December 2022 were enrolled in this single-center retrospective observational study. Preoperative status, operative findings, and postoperative course were retrospectively reviewed. The Cox proportional hazards model was used to evaluate the association between age and early postoperative mortality. RESULTS Among 142 patients, 43 (30.3%) and 99 (69.7%) were aged ≥80 and <80 years, respectively. Postoperative mortality within 30 days occurred in 24 (16.9%) patients (11/43 [25.6%] and 13/99 [13.1%] patients aged ≥80 and <80 years, respectively; hazard ratio = 1.95; P = 0.069). In a multivariable analysis, increased postoperative mortality within 30 days was associated with age ≥80 years (adjusted hazard ratio, aHR = 2.36; P = 0.049), the presence of preoperative or intraoperative cardiopulmonary arrest (aHR = 12.0; P < 0.001), and postoperative gastrointestinal disorder (aHR = 4.42; P = 0.003). CONCLUSIONS Endovascular aneurysm repair may be preferable in older people; however, its use in cases of preoperative or intraoperative cardiopulmonary arrest or perioperative gastrointestinal disorders remains controversial, and a careful discussion on the surgical indications is needed in such cases.
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Affiliation(s)
- Soichiro Kageyama
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
| | - Takeki Ohashi
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
| | - Akinori Kojima
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
| | - Taiki Kojima
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu-shi, Aichi, Japan; Division of Comprehensive Pediatric Medicine, Graduate School of Nagoya University, Showa-ku, Nagoya, Japan.
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Lauridsen SV, Bøtker MT, Eldrup N, Juhl-Olsen P. Prehospital point-of-care ultrasound in ruptured abdominal aortic aneurysms-a retrospective cohort study. Acta Anaesthesiol Scand 2024; 68:693-701. [PMID: 38415353 DOI: 10.1111/aas.14393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/14/2024] [Accepted: 02/04/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Patients with ruptured abdominal aortic aneurysm (rAAA) require immediate vascular treatment to survive. The use of prehospital point-of-care ultrasound (POCUS) may support clinical assessment, correct diagnosis, appropriate triage and reduce system delay. The aim was to study the process of care and outcome in patients receiving prehospital POCUS versus patients not receiving prehospital POCUS in patients with rAAA, ruptured iliac aneurysm or impending aortic rupture. METHODS We performed a retrospective cohort study in patients diagnosed with rAAA in the Central Denmark Region treated by a prehospital critical care physician from 1 January 2017 to 31 December 2021. Performance of prehospital POCUS was extracted from the prehospital electronic health records. System delay was defined as the time from the emergency phone call to the emergency medical service dispatch centre until the start of surgery. Data on patients primary hospital admission to a centre with/without vascular treatment expertise, treatments and complications including death were extracted from electronic health records. RESULTS We included 169 patients; prehospital POCUS was performed in 124 patients (73%). Emergency surgical treatment was performed in 71 patients. The overall survival in the POCUS group was 39% versus 16% in the NO POCUS group (hazard ratio (HR) (95% 0.60, 95% CI: 0.41-0.89, p = .011). In the POCUS group 99/124 (80%) were directly admitted to a vascular surgical centre versus 25/45 (56%) in the NO POCUS, RD 24% (95% CI: 8-40)), (p = .002). In the POCUS group, system delay was a median of 142 minutes (interquartile range (IQR) 121-189) and a median of 232 minutes (IQR 166-305) in the NO POCUS group (p = .006). In a multivariable analysis incorporating age, sex, previously known rAAA, and typical clinical symptoms of rAAA, the HR for death was 0.57, 95% CI 0.38-0.86 (p = .008) favouring prehospital POCUS. CONCLUSIONS Prehospital POCUS was associated with reduced time to treatment, higher chance of operability and significantly higher 30-day survival in patients with rAAA, ruptured iliac aneurysm or impending rupture of an AAA in this retrospective study. Residual confounding cannot be excluded. This study supports the clinical relevance of prehospital POCUS of the abdominal aorta.
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Affiliation(s)
- Signe Voigt Lauridsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Research and Development, Prehospital Emergency Medical Service, Central Denmark Region, Aarhus, Denmark
| | - Morten Thingemann Bøtker
- Department of Research and Development, Prehospital Emergency Medical Service, Central Denmark Region, Aarhus, Denmark
- Department of Anaesthesiology, Randers Region Hospital, Randers, Denmark
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Juhl-Olsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Seike Y, Yokawa K, Koizumi S, Shinzato K, Kasai M, Masada K, Inoue Y, Sasaki H, Matsuda H. The open-first strategy is acceptable for ruptured abdominal aortic aneurysm even in the endovascular era. Surg Today 2024; 54:138-144. [PMID: 37266802 DOI: 10.1007/s00595-023-02709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE To examine the surgical findings of ruptured abdominal aortic aneurysm (RAAA) based on the open-first strategy in the last decade, and to analyze the predictors of in-hospital mortality for RAAA in the endovascular era. METHODS The subjects of this retrospective study were 116 patients who underwent RAAA repair, for whom sufficient data were available [25% female, median age 76 (70-85) years]. Sixteen (13.8%) patients were managed with endovascular aneurysm repair (EVAR) and 100 patients (86.2%) were managed with open surgical repair (OSR). RESULTS Univariate analysis identified base excess (BE) (odds ratio [OR] 0.88; 95% confidence interval [CI] 0.79-0.96; p = 0.006), and preoperative cardiopulmonary arrest (CPA) [OR] 15.4; 95% [CI] 1.30-181; p = 0.030), BE (OR 0.88; 95% CI 0.79-0.96; p = 0.006), shock index (OR 2.44; 95% CI 1.01-5.94; p = 0.050), lactic acid (Lac) (OR 1.18; 95% CI 1.02-1.36; p = 0.026), and blood sugar (BS) > 215 (OR 3.46; 95% CI 1.10-10.9; p = 0.034) as positive predictors of hospital mortality. CONCLUSIONS The findings of this study suggest that a first-line strategy of OSR for ruptured AAAs is acceptable. Poor preoperative conditions, including a high shock index, CPA, low BE, high Lac, and a BS level > 215 mg/dl, were identified as predictors of hospital mortality, rather than the procedures themselves.
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Affiliation(s)
- Yoshimasa Seike
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Shigeki Koizumi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Kento Shinzato
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Mio Kasai
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Kenta Masada
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Yosuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan.
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Lim S, Kwan S, Colvard BD, d'Audiffret A, Kashyap VS, Cho JS. Impact of Interfacility Transfer of Ruptured Abdominal Aortic Aneurysm Patients. J Vasc Surg 2022; 76:1548-1554.e1. [PMID: 35752382 DOI: 10.1016/j.jvs.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/12/2022] [Accepted: 05/01/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Interfacility transfer (IT) of patients with ruptured (r) abdominal aortic aneurysm (AAA) occurs not infrequently for a higher level of care. This study evaluates using contemporary administrative database the impact of IT on mortality after rAAA repair. METHODS Healthcare Cost and Utilization Project Database for NY (2016) and NJ/MD/FL (2016-2017) were queried using ICD-10th edition to identify patients who underwent open and endovascular repair of AAA. Hospitals were categorized into quartiles (Q) per overall volume. Mortality rates of IT vs non-transferred (NT) rAAA patients per treatment modality (open [rOAR] vs. endovascular [rEVAR]) were compared. Cox proportional hazard model was used to estimate hazard ratios (HR) for mortality. RESULTS 1475 patients presented with rAAA of whom 672 (45.6%) were not treated. Of the remaining 803 patients, 226 (28.1%) were transferred; 50 (22.1%) died without a repair after IT. The remaining 752 patients (176 IT + 576 NT) underwent 491 rEVARs and 261 rOARs. Baseline characteristics were similar between IT and NT patients except for higher proportion of Blacks (P=.03), lower-income families (P=.049) and rOAR (45.5% vs 31.4%, p=.001) in IT patients. Overall mortality rates were similar between NT (30.2%) and IT (27.3%, P=.46). On sub-group analysis, operative mortality rates after rEVAR were similar between NT and IT patients, without differences among hospital quartiles. After rOAR, however, operative mortality rates were lower in IT patients, largely due to improved outcomes in Q4 hospitals (P=.001, Q4 vs Q1, 2 & 3). Cox regression analysis demonstrated age (HR 1.03, CI 1.00-1.06, P=.02) and low-volume hospitals (Q1-3) (HR 1.89, CI 1.02-3.51, P=.04) are predictors of mortality. Total charges were similar ($286,727 IT vs $265,717 NT, P=.38). CONCLUSIONS Less than 30% of rAAA patients deemed to be a candidate for repair are transferred. IT does not affect mortality rates after rEVAR, irrespective of hospital volume. For rOAR candidates, however, regionalization of care with prompt transfer to a high-volume center improves the survival benefits without increased health care cost.
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Affiliation(s)
- Sungho Lim
- Division of Vascular and Endovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Rush Medical College/Rush University Medical Center, Chicago, IL
| | - Stephen Kwan
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine/University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Benjamin D Colvard
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine/University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Alexandre d'Audiffret
- Division of Vascular and Endovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Rush Medical College/Rush University Medical Center, Chicago, IL
| | - Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine/University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine/University Hospitals, Cleveland Medical Center, Cleveland, OH.
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Dirks NPM, Mestrom M, van der Lugt M, van Osch F, Peters NALR, Elshof JWM, Barten DG. Utility of Shock Index for Suspected Rupture of Abdominal Aortic Aneurysms. PREHOSP EMERG CARE 2020; 25:496-503. [DOI: 10.1080/10903127.2020.1796184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sex Disparity in Outcomes of Ruptured Abdominal Aortic Aneurysm Repair Driven by In-hospital Treatment Delays. Ann Surg 2020; 270:630-638. [PMID: 31356266 DOI: 10.1097/sla.0000000000003482] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We sought to assess whether sex-related differences in timely repair of ruptured abdominal aortic aneurysm (rAAA) were associated with excess risk of early mortality in women. SUMMARY BACKGROUND DATA rAAA is a surgical emergency and timeliness of intervention affects outcomes. A door-to-intervention time of <90 minutes is recommended. METHODS All rAAA repairs in the Vascular Quality Initiative from 2003 to 2017 were reviewed. Patients were stratified by sex and time-delay cohorts. Univariate and multivariate analyses were performed. RESULTS There were 3719 rAAA repairs, of which 797 (21%) were performed in women. Sex did not affect repair type: open versus endovascular (21% females, each). Despite similar presentation delays [median 6 hours (inter quartile range, IQR: 3-16)], admission-to-intervention time was longer for women than men [median 1.5 hours (IQR 1-4] vs 1.2 hours (IQR 1-3), P=0.047]. Overall, 45% of patients had a >90-minute delay from admission to repair, with more women than men experiencing this delay (49% vs 44%, P=0.01). Neither were more likely to undergo transfer for treatment. After risk adjustment, female sex was associated with a 48% increase in 30-day mortality. Sex differences in mortality were no longer observed in patients with intervention delays of ≤90 minutes. In patients with >90-minute delays, a 77% increase in 30-day mortality of women over men was noted. CONCLUSIONS Nearly half of rAAA patients have a door-to-intervention time longer than recommended societal guidelines. Sex differences in mortality after rAAA repair seem to be driven by in-hospital treatment delays.
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Davis FM, Sutzko DC, Smith ME, Gallagher K, Henke PK, Osborne N. Variation in Hospital Door-to-Intervention Time for Ruptured AAAs and Its Association with Outcomes. Ann Vasc Surg 2019; 62:83-91. [PMID: 31201978 DOI: 10.1016/j.avsg.2019.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND A ruptured abdominal aortic aneurysm (rAAA) is a life-threatening condition that carries a high mortality rate. Recent guidelines have recommended a goal "door-to-intervention" time of ≤90 minutes despite a paucity of evidence to support this goal. The aim of this study was to analyze recent trends in door-to-intervention time for rAAAs and determine the effect of the 90-minute door-to-intervention benchmark on postoperative complications. METHODS A retrospective analysis of all patients who underwent open aortic repair (OAR) or endovascular aneurysm repair (EVAR) of a rAAA in the Vascular Quality Initiative database (2003-2018) was performed. Variation in door-to-intervention time was analyzed at the patient and hospital level. Patients were dichotomized into ≤90 or >90 minute door-to-intervention time cohorts. Hierarchical modeling controlling for the hospital random effect and multivariate logistic models was used to analyze the association on 30-day mortality and major in-hospital complications. RESULTS A total of 3,630 operative cases for rAAA were identified (1696 OAR and 1934 EVAR). For the OAR cohort, 1035 patients (61%) had a door-to-intervention time of ≤90 minutes. However, at the hospital level, a minority of hospitals (49%) reliably achieved the OAR goal door-to-intervention time. For OARs, there was no difference in 30-day risk-adjusted major complications or mortality between the ≤90- and > 90-minute cohorts. For EVAR, 1014 patients (53.8%) had a door-to-intervention time of ≤90 minutes and a minority of hospitals (40%) upheld the recommended ≤90 minute door-to-intervention threshold. In the EVAR group, patients with a ≤90 minute door-to-intervention time had higher rates of postoperative myocardial infarction (12.0% vs. 8.5%; P < 0.05) but no difference in 30-day risk-adjusted mortality. CONCLUSIONS A low percentage of rAAAs are being treated within the recommended door-to-intervention time. Despite this deficiency, the ≤90-minute benchmark has minimal impact on postoperative morbidity and mortality. Based on these findings, alternative quality metrics should be identified to improve the clinical care of patients with rAAA.
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Affiliation(s)
- Frank M Davis
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Danielle C Sutzko
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Margaret E Smith
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Katherine Gallagher
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Peter K Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Nicholas Osborne
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
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The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67:2-77.e2. [DOI: 10.1016/j.jvs.2017.10.044] [Citation(s) in RCA: 1150] [Impact Index Per Article: 191.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Kouvelos G, Katsargyris A, Töpel I, Steinbauer M, Verhoeven ELG. Aktuelle Therapieoptionen beim rupturierten abdominellen Aortenaneurysma. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0279-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Lijftogt N, Vahl AC, Wilschut ED, Elsman BHP, Amodio S, van Zwet EW, Leijdekkers VJ, Wouters MWJM, Hamming JF. Adjusted Hospital Outcomes of Abdominal Aortic Aneurysm Surgery Reported in the Dutch Surgical Aneurysm Audit. Eur J Vasc Endovasc Surg 2017; 53:520-532. [PMID: 28256396 DOI: 10.1016/j.ejvs.2016.12.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/25/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE/BACKGROUND The Dutch Surgical Aneurysm Audit (DSAA) is mandatory for all patients with primary abdominal aortic aneurysms (AAAs) in the Netherlands. The aims are to present the observed outcomes of AAA surgery against the predicted outcomes by means of V-POSSUM (Vascular-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity). Adjusted mortality was calculated by the original and re-estimated V(physiology)-POSSUM for hospital comparisons. METHODS All patients operated on from January 2013 to December 2014 were included for analysis. Calibration and discrimination of V-POSSUM and V(p)-POSSUM was analysed. Mortality was benchmarked by means of the original V(p)-POSSUM formula and risk-adjusted by the re-estimated V(p)-POSSUM on the DSAA. RESULTS In total, 5898 patients were included for analysis: 4579 with elective AAA (EAAA) and 1319 with acute abdominal aortic aneurysm (AAAA), acute symptomatic (SAAA; n = 371) or ruptured (RAAA; n = 948). The percentage of endovascular aneurysm repair (EVAR) varied between hospitals but showed no relation to hospital volume (EAAA: p = .12; AAAA: p = .07). EAAA, SAAA, and RAAA mortality was, respectively, 1.9%, 7.5%, and 28.7%. Elective mortality was 0.9% after EVAR and 5.0% after open surgical repair versus 15.6% and 27.4%, respectively, after AAAA. V-POSSUM overestimated mortality in most EAAA risk groups (p < .01). The discriminative ability of V-POSSUM in EAAA was moderate (C-statistic: .719) and poor for V(p)-POSSUM (C-statistic: .665). V-POSSUM in AAAA repair overestimated in high risk groups, and underestimated in low risk groups (p < .01). The discriminative ability in AAAA of V-POSSUM was moderate (.713) and of V(p)-POSSUM poor (.688). Risk adjustment by the re-estimated V(p)-POSSUM did not have any effect on hospital variation in EAAA but did in AAAA. CONCLUSION Mortality in the DSAA was in line with the literature but is not discriminative for hospital comparisons in EAAA. Adjusting for V(p)-POSSUM, revealed no association between hospital volume and treatment or outcome. Risk adjustment for case mix by V(p)-POSSUM in patients with AAAA has been shown to be important.
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Affiliation(s)
- N Lijftogt
- Department of Vascular Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - A C Vahl
- Department of Surgery, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - E D Wilschut
- Department of Vascular Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - B H P Elsman
- Department of Vascular Surgery, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands
| | - S Amodio
- Department of Medical Statistics, Leiden University, Einthovenweg 20, 2333 ZC, Leiden, The Netherlands
| | - E W van Zwet
- Department of Medical Statistics, Leiden University, Einthovenweg 20, 2333 ZC, Leiden, The Netherlands
| | - V J Leijdekkers
- Department of Surgery, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - M W J M Wouters
- Department of Surgery, Dutch Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands
| | - J F Hamming
- Department of Vascular Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Mell MW, Starnes BW, Kraiss LW, Schneider PA, Pevec WC. Western Vascular Society guidelines for transfer of patients with ruptured abdominal aortic aneurysm. J Vasc Surg 2017; 65:603-608. [DOI: 10.1016/j.jvs.2016.10.097] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/08/2016] [Indexed: 11/29/2022]
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12
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Ruptured aneurysm systems of care: A national imperative to improve clinical outcomes. J Vasc Surg 2017; 65:589-590. [DOI: 10.1016/j.jvs.2016.10.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/14/2016] [Indexed: 12/16/2022]
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13
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Hope K, Nickols G, Mouton R. Modern Anesthetic Management of Ruptured Abdominal Aortic Aneurysms. J Cardiothorac Vasc Anesth 2016; 30:1676-1684. [DOI: 10.1053/j.jvca.2016.03.147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Indexed: 01/16/2023]
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Qiu J, Zhou W, Zhou W, Tang X, Yuan Q, Xiong J. The beneficial place for the treatment of ruptured abdominal aortic aneurysms. Int J Surg 2016; 36:104-108. [PMID: 27773597 DOI: 10.1016/j.ijsu.2016.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To study the beneficial place for the treatment of ruptured abdominal aortic aneurysms (RAAAs). METHOD A retrospective chart review of consecutive RAAA patients was performed. Patients were divided into two groups: direct group and transfer group. We retrospectively reviewed patients' hospital charts and recorded various clinical factors apparent on presentation. The primary consequence was mortality during hospitalization, and some other parameters such as duration of intensive care unit (ICU). All patients were followed up at 1 month, 3 months, 6 months and one year after discharge. RESULTS During 4-year period, 56 RAAA patients were treated (24 in direct group, and 32 in transfer group). Significant differences were shown for systolic blood pressure, pulse oxygen saturation, hemoglobin, the time interval from diagnosis to operation et al. There was no difference concerning age and comorbidity among two groups. All the patients were treated by open surgical aneurysm repair. The mortality rate was 68.8% ((6 + 16)/32) in transfer group and 33.3% (8/24) in direct group (P = 0.00067). Both the duration of ICU stay and entire hospitalization were a bit longer in the transfer group, but there was no significant difference. The mean follow-up time was 25.2 ± 12.9 months. The cumulative survival difference was significant (P = 0.042) between the two groups. CONCLUSION It is beneficial that we treat RAAAs in the diagnosed hospital. The reasons are: 1) to avoid the development of unstable state of aneurysm after rupturing of stable state; 2) the time interval from initial symptoms to operation will be shortened.
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Affiliation(s)
- Jiehua Qiu
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China
| | - Weimin Zhou
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China.
| | - Wei Zhou
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China
| | - Xinhua Tang
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China
| | - Qingwen Yuan
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China
| | - Jixin Xiong
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China
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Maltha M, Visser A, Sandjer T, Jahrome A, Vink T, ter Avest E. When to activate a multidisciplinary team for an acute abdominal aortic aneurysm? Am J Emerg Med 2016; 34:1519-23. [DOI: 10.1016/j.ajem.2016.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/28/2016] [Accepted: 05/07/2016] [Indexed: 02/05/2023] Open
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A new metric for centralization of ruptured abdominal aortic aneurysm repair in large territories. J Vasc Surg 2015; 62:862-7. [DOI: 10.1016/j.jvs.2015.04.442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/27/2015] [Indexed: 11/19/2022]
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Mell MW, Wang NE, Morrison DE, Hernandez-Boussard T. Interfacility transfer and mortality for patients with ruptured abdominal aortic aneurysm. J Vasc Surg 2014; 60:553-7. [DOI: 10.1016/j.jvs.2014.02.061] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/26/2014] [Indexed: 10/25/2022]
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Hinchliffe RJ, Powell JT. Improving the outcomes from ruptured abdominal aortic aneurysm: interdisciplinary best practice guidelines. Ann R Coll Surg Engl 2013; 95:96-7. [PMID: 23484988 PMCID: PMC4098596 DOI: 10.1308/003588413x13511609956778] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- R J Hinchliffe
- St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK.
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Changes in abdominal aortic aneurysm rupture and short-term mortality, 1995-2008: a retrospective observational study. Ann Surg 2012; 256:651-8. [PMID: 22964737 DOI: 10.1097/sla.0b013e31826b4f91] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the modern epidemiology of abdominal aortic aneurysm (AAA) rupture and short-term AAA-related mortality after the introduction of endovascular aneurysm repair (EVAR). BACKGROUND Previous epidemiologic studies have demonstrated stable rates of AAA repair, repair mortality, and AAA rupture. Recently, EVAR has been introduced as a less invasive treatment method, and its use has expanded to more than 75% of elective AAA repairs. METHODS We identified Medicare beneficiaries undergoing AAA repair and those hospitalized with a ruptured AAA during the period 1995 to 2008 and calculated standardized annual rates of AAA-related deaths due to either elective repair or rupture. RESULTS A total of 338,278 patients underwent intact AAA repair during the study period. There were 69,653 patients with AAA rupture, of whom 47,524 underwent repair. Intact repair rates increased substantially in those older than 80 years (57.7-92.3 per 100,000, P < 0.001) but decreased in those 65 to 74 years old (81.8-68.9, P < 0.001). A decline in ruptures with and without repair was seen in all age groups. By 2008, 77% of all intact repairs and 31% of all rupture repairs were performed with EVAR (P < 0.001). Operative mortality declined during the study period for both intact (4.9%-2.4%, P < 0.001) and ruptured (44.1%-36.3%, P < 0.001) AAA repair. Short-term AAA-related deaths decreased by more than half (26.1-12.1 per 100,000, P < 0.001), with the greatest decline occurring in those older than 80 years (53.7-27.3, P < 0.001). CONCLUSIONS A recent decline in AAA rupture and short-term AAA-related mortality is demonstrated and likely related in part to the introduction and expansion of EVAR. This is due to decreased deaths from ruptures (with and without repair) and decreased mortality with intact repairs, particularly in patients older than 80 years.
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Mell MW, Callcut RA, Bech F, Delgado MK, Staudenmayer K, Spain DA, Hernandez-Boussard T. Predictors of emergency department death for patients presenting with ruptured abdominal aortic aneurysms. J Vasc Surg 2012; 56:651-5. [DOI: 10.1016/j.jvs.2012.02.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 11/17/2022]
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Brattheim B, Eikemo T, Altreuther M, Landmark A, Faxvaag A. Regional Disparities in Incidence, Handling and Outcomes of Patients with Symptomatic and Ruptured Abdominal Aortic Aneurysms in Norway. Eur J Vasc Endovasc Surg 2012; 44:267-72. [DOI: 10.1016/j.ejvs.2012.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 04/30/2012] [Indexed: 10/28/2022]
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Kolh P. Acute abdominal aortic aneurysm: significant regional differences across Norway. Eur J Vasc Endovasc Surg 2012; 44:273. [PMID: 22818803 DOI: 10.1016/j.ejvs.2012.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 06/11/2012] [Indexed: 11/25/2022]
Affiliation(s)
- P Kolh
- Cardiovascular Surgery Department, University of Liège Hospital, CHU B35 Sart Tilman, Liège, Belgium.
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Hinchliffe RJ, Ribbons T, Ulug P, Powell JT. Transfer of patients with ruptured abdominal aortic aneurysm from general hospitals to specialist vascular centres: results of a Delphi consensus study. Emerg Med J 2012; 30:483-6. [PMID: 22761515 PMCID: PMC3664393 DOI: 10.1136/emermed-2012-201239] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Aim To explore areas of consensus and disagreement concerning the interhospital transfer of patients with a clinical diagnosis of ruptured abdominal aortic aneurysm. Methods A three-round Delphi questionnaire approach was used among vascular and endovascular surgery and emergency medicine specialists to explore patient characteristics and clinical management issues for emergency interhospital transfer. Analysis is based on 38 responses to rounds 2 and 3 (19 vascular surgeons, 6 interventional radiologists, 13 emergency care specialists) with agreement reported when 70% of respondents were in agreement. Results Initially there was agreement that transfer patients should be <85 years of age, either alert or with fluctuating consciousness, with moderate or minimal systemic disease, needing no/some help with daily living. Round 3 clarified that patients requiring inotropes and those institutionalised for mental infirmity should be transferred. Those with cardiac arrest in current episode should not be transferred. There was no agreement as to whether those institutionalised with physical infirmities, unconscious/intubated patients or those with severe systemic disease should be transferred. Speed was accepted as important, with agreement for specialty trainees to arrange transfer if consultants were not on site. Consultant–consultant discussion was recommended for patients with severe systemic disease. CT confirmation of diagnosis was considered unnecessary before transfer but ultrasound assessment was desirable, and transfers should not be delayed by waiting for specific tests. There was no agreement about blood tests and ECG before transfer or whether blood should accompany the patient being transferred. There was no agreement as to whether specific staff/facilities needed to be in place at the specialist hospital. A systolic blood pressure ≥70 mm Hg was sufficient for transfer without the need for intravenous fluids unless deterioration occurred. Conclusions There is broad agreement about the type of patient who should be eligible for transfer but disagreements about patient management before and during transfer remain.
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Affiliation(s)
- Robert J Hinchliffe
- St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK
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Scheer MLJ, Pol RA, Haveman JW, Tielliu IFJ, Verhoeven ELG, Van Den Dungen JJAM, Nijsten MW, Zeebregts CJ. Effectiveness of treatment for octogenarians with acute abdominal aortic aneurysm. J Vasc Surg 2011; 53:918-25. [PMID: 21211933 DOI: 10.1016/j.jvs.2010.10.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 10/12/2010] [Accepted: 10/13/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether advanced age may be a reason to refrain from treatment in patients with an acute abdominal aortic aneurysm (AAAA). METHODS This was a retrospective cohort study that took place in a tertiary care university hospital with a 45-bed intensive care unit. Two hundred seventy-one patients with manifest AAAA, admitted and treated between January 2000 and February 2008, were included. Six patients died during operation and were included in the final analysis to ensure an intention-to-treat protocol, resulting in 234 men and 37 women with a mean age of 72 ± 7.8 years (range, 54-88 years). Forty-six patients (17%) were 80 years or older. Interventions involved open or endovascular AAAA repair. RESULTS Mean follow-up was 33 ± 30.4 months (including early deaths). Mean hospital length of stay was 16.9 ± 20 days for patients younger than 80 and 13 ± 16.7 days for patients older than 80 years of age. Kaplan-Meier survival analysis revealed a significantly better survival for the younger patients (P < .05). Stratification based on urgency or type of treatment did not change the difference. Two-year actuarial survival was 70% for patients younger than 80 and 52% for those older than 80. At 5-year follow-up, these figures were 62% and 29%, respectively. Mean survival in patients older than 80 was 39.8 ± 6.8 months versus 64.5 ± 3.0 months in those younger than 80. CONCLUSIONS For octogenarians, our liberal strategy of treating patients with AAAA was associated with satisfactory short- and long-term outcome, with no difference with regard to disease- or procedure-related morbidity between the younger and older group. Assuming an integrated system for managing AAAA is in place, advanced age is not a reason to deny patients surgery.
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Affiliation(s)
- Margot L J Scheer
- Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands
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Verhoeven EL, Kapma MR, Groen H, Tielliu IF, Zeebregts CJ, Bekkema F, van den Dungen JJ. Mortality of ruptured abdominal aortic aneurysm treated with open or endovascular repair. J Vasc Surg 2008; 48:1396-400. [DOI: 10.1016/j.jvs.2008.07.054] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 07/12/2008] [Accepted: 07/15/2008] [Indexed: 02/06/2023]
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Haveman JW, Zeebregts CJ, Verhoeven ELG, van Den Berg P, van Den Dungen JJAM, Zwaveling JH, Nijsten MWN. Changes in laboratory values and their relationship with time after rupture of an abdominal aortic aneurysm. Surg Today 2008; 38:1091-101. [DOI: 10.1007/s00595-008-3798-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2007] [Accepted: 04/09/2008] [Indexed: 11/29/2022]
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