Key result
Patient transfer from an outside institution did not significantly affect 30-day mortality compared to local arrival after open repair of ruptured abdominal aortic aneurysms (25.6% vs 18.2%; p=0.41).
Why the study?
Does patient transfer affect mortality in patients undergoing open repair for ruptured abdominal aortic aneurysms?
Cohort (n=83)
No
Does patient transfer affect mortality in patients undergoing open repair for ruptured abdominal aortic aneurysms?
Absolute Event Rate: 25.6% vs 18.2%
p-value: p=0.41
Patient transfer does not adversely affect mortality after open repair of ruptured abdominal aortic aneurysms, whereas hemodynamic instability significantly increases mortality.
Transfer may not increase mortality after open rAAA repair; hypothesis-generating and requires prospective confirmation.
Patients with ruptured abdominal aortic aneurysms (RAAAs) benefit from treatment in high-volume facilities. This study explored the effect of patient transfer on outcomes and the relationship between hemodynamic status and mortality. We performed a retrospective review of 83 consecutive patients who had open repair for RAAA at a single tertiary facility. The patients were divided into two groups based on arrival in the local emergency department, "local" (n = 44) versus "transfer" (n = 39) from an outside institution, and into three categories of hemodynamic status: (a) no obtainable blood pressure, "pulseless"; (b) requiring vasopressor support, "pressors"; and (c) no vasopressor support, "no pressors." Thirty-day mortality was 21.4%. There was no difference in mortality between the local (18.2%) and transfer (25.6%) patients (p = .41). There were no deaths during transfer. There was no difference in the hemodynamic status of the transfer versus the local group (p = .34). The mortality by category was pulseless, 100% (3 of 3); pressors, 71.4% (10 of 14); and no pressors, 7.6% (5 of 66) (p < .0001). Actuarial survival was 66%, 64%, and 62% at 1, 3, and 5 years, respectively. Patient transfer does not adversely affect mortality after RAAA repair. Patients without a palpable pulse and those requiring hemodynamic support have a significantly higher mortality.
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Azizzadeh et al. (2009) conducted a cohort in Ruptured abdominal aortic aneurysms (n=83). Patient transfer from an outside institution vs. Local arrival in the emergency department was evaluated on 30-day mortality (p=0.41). Patient transfer from an outside institution did not significantly affect 30-day mortality compared to local arrival after open repair of ruptured abdominal aortic aneurysms (25.6% vs 18.2%; p=0.41).
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