Surgical repair of ruptured abdominal aortic aneurysms by high-volume surgeons was associated with lower mortality, and overall statewide mortality declined from 59.3% to 43.2% (P=0.039).
Cross-Sectional (n=527)
Yes
What patient and provider factors influence operative mortality, length of stay, and hospital charges after surgical repair of ruptured abdominal aortic aneurysms?
Operative mortality for ruptured AAA repair declined significantly in Maryland between 1990 and 1995, with better outcomes and lower costs associated with high-volume surgeons.
Absolute Event Rate: 43.2% vs 59.3%
p-value: p=0.039
PURPOSE: Abdominal aortic aneurysm (AAA) rupture has been historically associated with high operative mortality rates. In this community-based, cross-sectional study, we examined factors influencing outcome after operations performed for ruptured AAA (rAAA). METHODS: An analysis of a state database identified 3820 patients who underwent AAA repair between 1990 and 1995, including 527 (13.8%) who had an operation for an rAAA. Demographic variables examined included patient age, gender, race, associated comorbidity rates, operative surgeon experience with rAAA, and annual hospital rAAA and total AAA operative volumes. Outcomes measured included operative mortality rates, hospital length of stay, and charges. RESULTS: Operative mortality rates increased significantly with advancing age (P < 0.0001) but were not related to gender (P = 0.474) or race (p = 0.598) and were significantly lower among patients with hypertension (P = 0.006) or pulmonary disease (P = 0.045). There was no relationship between hospital rAAA or total AAA volume and rAAA repair mortality rate, although high-volume surgeons (i.e., performing more than 10 rAAA repairs) had decreased mortality rates and hospital charges compared with other surgeons. Hospital lengths of stay and charges increased with age among survivors, but not nonsurvivors, of rAAA repair. Despite a stable incidence of rAAA repairs during the study interval and no significant change in the mean age of patients undergoing operation or the percentage of operations performed by high-volume surgeons, the statewide mortality rate declined from 59.3% to 43.2% (P = 0.039). CONCLUSION: The incidence of rAAA does not appear to be declining. Although operative rAAA repair continues to be associated with substantial risk and remains an especially lethal condition among the elderly, the operative mortality rate has declined in recent years in Maryland. Lower operative mortality rates and hospital charges are associated with operations performed by high-volume surgeons.
Dardik et al. (1998) conducted a cross-sectional in Ruptured abdominal aortic aneurysm (n=527). Recent study interval (1995) vs. Earlier study interval (1990) was evaluated on Statewide operative mortality rate (p=0.039). Surgical repair of ruptured abdominal aortic aneurysms by high-volume surgeons was associated with lower mortality, and overall statewide mortality declined from 59.3% to 43.2% (P=0.039).