Outcome of treatment of ruptured abdominal aortic aneurysms depending on the type of hospital.
OBJECTIVE
To compare the outcome of patients operated on acutely for ruptured abdominal aortic aneurysms (AAA) or otherwise symptomatic aortic aneurysms in a university hospital and in two county hospitals by the same group of vascular surgeons.


METHODS
Retrospective study.


METHODS
1 university and 2 county hospitals, Sweden.


METHODS
108 patients operated on urgently for AAA, 81 at the university hospital, and 27 at the county hospitals between January 1992 and December 1998.


METHODS
Repair of the AAA.


METHODS
Morbidity and mortality.


RESULTS
21 of the 81 patients having urgent repair of an AAA at the university hospital (26%) had been transferred from the county hospitals. Thirteen patients were not operated on, 7 because of their poor general condition and great age (median 84 years), 3 who refused operation, and 3 in whom the diagnosis was incorrect. During the same time period a further 27 haemodynamically unstable patients were operated on by the same vascular surgeons at the county hospitals. The on-table mortality for patients with ruptured AAA and shock was 5/43 (12%) at the university hospital and 4/27 (15%) at the county hospitals. The corresponding in-hospital rates were 11/43 (26%) and 11/27 (41%). Mortality was significantly higher if the operation was delayed by more than 45 minutes. The incidence of postoperative complications was the same in both hospitals.


CONCLUSIONS
If a patient with a ruptured AAA and shock is admitted to the county hospital and operated on by a specialist vascular surgeon the outcome is fully acceptable. The difference seems to be related to the postoperative period. To what extent the delay caused by the surgeon's journey to the county hospital has any influence on the outcome is not possible to evaluate.
Department of Surgery, University Hospital, Lund, Sweden.
Z
Z
Zdanowski
G
G
Danielsson
T
T
Jonung
J
J
Kaij
E
E
Ribbe
Ch
Ch
Sahlin
P
P
Schatz
J
J
Thörne
L
L
Norgren
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006766:Hospitals, County / Q000592:standards*; D006785:Hospitals, University / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011787:Quality of Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013548:Sweden; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000592:standards