Quality assessment of elective abdominal aortic aneurysm repair from referral to surgery

BACKGROUND: The risk of rupture for a large (≥ 55 mm) abdominal aortic aneurysm(AAA) is significant and therefore operative treatment should take place before possible aneurysm rupture. Timing of elective AAA surgery has rarely been investigated previously. The aim of this study is to evaluate success in the elective treatment process of large AAAs from referral to surgery in Helsinki University Central Hospital. PATIENTS AND METHODS: We retrospectively analyzed all 361 patients who were assigned for elective treatment of AAA during 2005 - 2010. We divided the patients into subgroups according to size of the aneurysm: <60 mm, 61 - 70 mm and >70 mm. The main focus was set on the preoperative period and on potential factors causing delay. End points indicating failure in the treatment process were aneurysm ruptures and deaths before surgery. RESULTS: The median time from referral to surgery for the three subgroups was 112, 91 and 45 days respectively (p < 0,001). There were no significant differences between the treatment methods: open repair (OR) with 103 days and endovascular aortic repair (EVAR) with 113 days until surgery. Twenty three (6.4 %) patients were operated on emergency basis while waiting for the operation, six of them for ruptured aneurysm. There were an additional five patients with aneurysm ruptures who all died, as did four out the six operated ones. CONCLUSIONS: The whole treatment process starting from the referral should be considered in order for elective AAA treatment to succeed. Recommendations should be established for the preoperative period to guarantee rapid preoperative evaluation.