Key result
Only ~10% of rAAA patients achieve target door-to-intervention times, with faster care linked to higher mortality.
Why the study?
Society of Vascular Surgery guidelines advise a door-to-intervention time of 90 minutes or less for ruptured abdominal aortic aneurysms, but the authors hypothesised that this metric would not predict outcomes because treatment timelines reflect physiological severity, diagnostic assessment, and operative modality.
Does achieving a door-to-intervention time of <=90 minutes improve mortality and morbidity outcomes in patients undergoing surgical repair for ruptured abdominal aortic aneurysm?
Cohort (n=29)
No
Does achieving a door-to-intervention time of <=90 minutes improve mortality and morbidity outcomes in patients undergoing surgical repair for ruptured abdominal aortic aneurysm?
Nearly 90% of rAAA patients at a UK center exceeded the SVS 90-minute door-to-intervention target, and paradoxically shorter intervention times were associated with worse complications and 30-day mortality, likely reflecting confounding by physiological severity.
Answers are grounded in this paper and cite their sources.
Door-to-intervention times rarely meet SVS targets; leaves open whether system-level changes can improve compliance.
INTRODUCTION: Ruptured abdominal aortic aneurysms (rAAAs) are a life-threatening condition requiring rapid surgical intervention for survival. Guidelines from the Society of Vascular Surgery in 2018 advised a door-to-intervention time of ≤90 minutes. We hypothesised that door-to-intervention time would not predict outcomes following rAAA repair, as treatment timelines may reflect differences in physiological severity, diagnostic assessment and operative modality, including the use of EVAR. METHODS: This was a retrospective cohort study of 29 patients presenting to University Hospitals Plymouth (UHP) who underwent surgical intervention for rAAA between February 2018 and December 2024. The primary outcome was the proportion of patients achieving the SVS-recommended door-to-intervention time of ≤90 minutes. Secondary outcomes were the rates of endovascular repair (EVAR) compared to open repair and the associated mortality and morbidity. RESULTS: Twenty-nine patients were included, of whom only three (10.3%) met the SVS target. Median door-to-intervention time was 182 minutes. Arrival-to-diagnosis time was associated with the greatest delay, with a median time of 84 minutes. Twenty-three patients (79.3%) underwent open repair, with a 60.9% (14/23) mortality rate compared to 16.7% (1/6) for EVAR cases. Shorter door-to-intervention time was associated with higher 30-day mortality, although no association was observed with overall mortality. Morbidity rates were 95.6% (22/23) for open cases and 50.0% (3/6) for EVAR cases. No statistically significant association was identified between overall morbidity rates and door-to-intervention time. However, higher grade complications were statistically significantly associated with both shorter arrival to diagnosis time (p=0.011) and shorter arrival to knife-to-skin time (p=0.039). CONCLUSIONS: 89.7% (26/29) of rAAAs presenting to UHP between February 2018 and December 2024 exceeded the recommended SVS door-to-intervention target of <90 minutes. Shorter timelines were observed among patients with higher grade complications and who subsequently died. Mortality was higher following open repair.
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Narayanan et al. (2026) conducted a cohort in Ruptured abdominal aortic aneurysm (rAAA) (n=29). Door-to-intervention time and surgical repair (Open repair or EVAR) vs. SVS-recommended door-to-intervention target of <=90 minutes (and EVAR vs open repair) was evaluated on Proportion of patients achieving the SVS-recommended door-to-intervention time of <=90 minutes. Door-to-intervention time <=90 minutes was achieved in only 10.3% (3/29) of rAAA patients (median 182 min), with shorter times associated with higher 30-day mortality.
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