Influence of presentation on outcome in abdominal aortic aneurysm repair.
OBJECTIVE
In the absence of formal screening abdominal aortic aneurysms (AAA) are detected in an opportunistic manner. Many remain asymptomatic and undetected until they rupture. Incidentally discovered small AAAs are entered into a surveillance programme until they reach a suitable size for repair. The aim of this study was to examine trends in the management of AAA and whether the method of presentation had an effect on subsequent mortality.


METHODS
Observational study in UK district general hospital.


METHODS
This study reports a single surgeon case series identified using a prospectively maintained database. Data on mode of presentation, management and mortality were retrieved from case notes, PIMS hospital database and the Office of National Statistics.


RESULTS
Two hundred and five patients were referred with AAAs between 1992 and 2004, 78% presenting in elective circumstances. The surveillance programme fed 33% of the operated cases. Two aneurysms ruptured whilst under surveillance. Overall elective operative mortality was 11.8% and has progressively decreased over time. Thirty-day operated mortality was significantly lower in patients having a period of surveillance than those having immediate elective repair (2.3 vs. 16.3%, p=0.018). A slight reduction in emergency AAA repairs was noted over the study period (r2=0.6) although registered aneurysm deaths continue to increase (r2=0.83).


CONCLUSIONS
Elective mortality following AAA surgery decreased over the study period. Outcome was better in those patients who had surgery for aneurysms that had been under surveillance. Despite opportunistic screening the population adjusted mortality rate of aortic aneurysms showed a progressive increase. A reduction in deaths from aneurysms is unlikely without a formal screening programme.
Princess of Wales Hospital, Coity Rd, Bridgend CF31 1RQ, UK.
D A
DA
Harris
A
A
Al-Allak
J
J
Thomas
A R
AR
Hedges
D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D002391:Catchment Area, Health; D019992:Databases as Topic; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D011159:Population Surveillance; D011446:Prospective Studies; D006113:United Kingdom / Q000453:epidemiology