title: Community and hospital outcome from ruptured abdominal aortic aneurysm within the catchment area of a regional vascular surgical service.
abstract: OBJECTIVE
  The objective of this study was to examine patterns of referral, management, and outcome of patients with ruptured abdominal aortic aneurysm (RAAA) within the catchment area of this regional vascular unit (RVU).
  
  
  METHODS
  Referral, management, and outcome data regarding 972 consecutive patients admitted to the hospital or certified deceased in the community because of RAAA between January 1, 1989, and December 31, 1995, were retrieved from prospectively gathered computerized national and local databases.
  
  
  RESULTS
  Of 381 (39.2%) patients admitted to this unit, 316 (82.9%) underwent surgery, and of those, 188 (59.5%) survived. There was no significant difference in overall mortality between patients who were admitted directly to this unit (152 of 310, 49%) and those who were transferred from elsewhere (41 of 71, 58%). Surgical patients traveled significantly farther to the RVU than nonsurgical patients (P <.001), but there was no significant difference in traveling distance between surgical patients who survived and those who did not. Of 372 (38%) patients who were admitted to other units and not transferred, 24 (6.4%) underwent surgery and 14 (3.8%) survived. Of 972 patients, the overall community mortality from RAAA was 770 (79%).
  
  
  CONCLUSIONS
  Transferring patients from outlying units did not appear to prejudice operative outcome in this RVU. However, less than half of all RAAA patients were transferred, and only a small minority of those not transferred underwent surgery. Although the overall community mortality from RAAA was similar to that reported in earlier studies from other regions and countries where centralization has not occurred, centralization of vascular surgical services may be associated with an inappropriately low operation and survival rate for those patients who are not transferred to the regional center. The effect of centralization on the community outcome of emergent vascular surgical conditions requires further investigation.
authors.affiliation: Vascular Surgery Unit, University Department of Clinical and Surgical Sciences, Royal Infirmary, Edinburgh, Scotland.
authors.forename: D J
authors.initials: DJ
authors.lastname: Adam
authors.forename: I V
authors.initials: IV
authors.lastname: Mohan
authors.forename: W P
authors.initials: WP
authors.lastname: Stuart
authors.forename: M
authors.initials: M
authors.lastname: Bain
authors.forename: A W
authors.initials: AW
authors.lastname: Bradbury
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery; D001019:Aortic Rupture / Q000401:mortality* / Q000601:surgery; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D015276:Health Care Rationing; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012606:Scotland / Q000453:epidemiology; D013222:State Medicine; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data