Delay in Surgery for Ruptured Aortic Aneurysm in Hemodynamically Stable Patients: A Multicenter Retrospective Analysis

Thoracic aortic aneurysm or abdominal aortic aneurysm (TAA/AAA) is a fatal surgical emergency, and time to surgery can be a key factor in improving survival outcomes in patients. In this study, we examined the association between systolic blood pressure on arrival and door-to-surgery time in patients with ruptured TAA/AAA, hypothesizing that patients with ruptured thoracic or abdominal aortic aneurysms without hypotension may have longer door-to-surgery times than those with hypotension. This retrospective study was conducted at two community hospitals, Shonan Kamakura General Hospital and Tokyo Nishi Tokushukai Hospital, in Japan, and included patients with ruptured thoracic or abdominal aortic aneurysms who were admitted to these hospitals from 2010 to 2021. Door-to-surgery time was compared between patients with stable blood pressure (>90 mmHg) and those with hypotension (≤90 mmHg) using multivariable linear regression. Among 94 patients (median age 82 years), 29.8% were in hypotension on arrival. Hemodynamically stable patients had a longer door-to-surgery time than those with hypotension (152 vs. 95.5 min, p = 0.003). Multivariable analysis showed significantly shorter door-to-surgery times for patients with hypotension (percent difference, -26.3%; 95% CI, -48.7% to -4.0%). Hemodynamically stable patients with ruptured TAA/AAA can have longer door-to-surgery times, leading to avoidable delays in successful treatment. This study underscores the need for heightened clinical vigilance among physicians, as a delay in treatment may lead to worse outcomes in these patients.