Key result
Transfer for ruptured AAA is linked to a ~119% increase in postoperative complications versus direct presentation.
Why the study?
Centralisation of vascular services in the UK requires transfer of patients with ruptured abdominal aortic aneurysm to vascular centres, but the impact on outcomes is unclear.
Does inter-hospital transfer for ruptured abdominal aortic aneurysm increase mortality or morbidity compared to direct presentation to a vascular center?
Cohort (n=70)
Yes
Does inter-hospital transfer for ruptured abdominal aortic aneurysm increase mortality or morbidity compared to direct presentation to a vascular center?
Transferring patients with ruptured abdominal aortic aneurysms to a centralized vascular unit does not appear to increase mortality, though it is associated with higher postoperative morbidity.
Answers are grounded in this paper and cite their sources.
Transfer for rAAA was not linked to higher mortality but more complications; leaves open centralization benefits in observational data.
INTRODUCTION Rupture of abdominal aortic aneurysm is a surgical emergency. In order to improve operative outcomes, vascular services have been centralised in the United Kingdom. This means that a patient may present to a hospital with a ruptured aneurysm, but require transfer to a vascular centre for definitive treatment. METHODS This retrospective cohort study identified patients who underwent surgery for ruptured abdominal aortic aneurysm in a tertiary vascular centre over a 2-year period. Data on demographics and originating unit were recorded. Outcomes assessed included 30-day mortality, operative mortality and postoperative morbidity. RESULTS We identified 70 patients who underwent surgery for ruptured abdominal aortic aneurysm in the 2-year period; 36 presented directly to the vascular unit (VU), 14 to referral unit 1 (RU1) and 20 to referral unit 2 (RU2); 30-day mortality rates were 27.7% (VU), 35.5% (RU1) and 30.0% (RU2), respectively. There was no statistical difference in mortality between units. Postoperative complications were seen in 35.9% of VU patients, 78.6% of RU1 patients and 70% of RU2 patients. This was statistically significant between VU and RU1 (P = 0.006) and VU and RU2 (P = 0.02). Direct operative complications were seen in 9 patients, gastrointestinal complications in 9, limb complications in 6 and systemic complications in 40. CONCLUSION This study found that site of presentation does not affect mortality but is associated with increased morbidity. This is a complex issue, which will require a prospective multicentre study to investigate further.
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Proctor et al. (2016) conducted a cohort in Ruptured abdominal aortic aneurysm (n=70). Presentation to a referral unit requiring transfer vs. Direct presentation to the vascular unit was evaluated on Postoperative complications (p=0.006). Transfer from a referral unit for ruptured abdominal aortic aneurysm surgery increased postoperative complications compared to direct presentation (78.6% and 70.0% vs 35.9%; P=0.006 and P=0.02).
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