title: Impact of delay on survival in patients with ruptured abdominal aortic aneurysm.
abstract: Rupture of the abdominal aortic aneurysm (RAAA) is a common surgical emergency. Surgical treatment of this condition carries a high morbidity and mortality rate. For successful outcome, an early diagnosis and prompt treatment are essential. However, recently, some centers have reported better results in patients whose surgery had been delayed because of interhospital transfer. Delay in treatment sometimes occurs as patients are transferred from one institution to another where specialized vascular care is available. This retrospective study sought to determine the effect of delay in treatment on the mortality of patients with RAAA repair.The time from arrival at the emergency room to surgery and operative time were obtained from the case notes of 45 consecutive patients with RAAA. Patients' physiology scores on admission were calculated using V-POSSUM for the RAAA model.Thirty-five patients were diagnosed with RAAA in the emergency room and were transferred to surgery. These patients were divided into two groups: patients who had surgery within 1 hour (n = 23) and those in whom surgery was delayed for up to 4 hours (n = 12). There was no significant difference in physiology score between the two groups (p = .12). The time to surgery and operative time with death as the outcome were plotted on a logistic regression model that showed that the delay in surgical treatment increases the mortality rate following RAAA repair (p = .041). Furthermore, a long operative time was associated with a higher surgical mortality rate (p = .029). Delay to surgery and a long operation increase the mortality rate following RAAA repair. However, delay to surgery alone did not influence the mortality rate.
authors.affiliation: Suffolk Vascular Unit, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK. msalhab1@doctors.org.uk
authors.forename: Mohamed
authors.initials: M
authors.lastname: Salhab
authors.forename: Jessica
authors.initials: J
authors.lastname: Farmer
authors.forename: Isam
authors.initials: I
authors.lastname: Osman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000503:physiopathology / Q000601:surgery*; D002983:Clinical Competence; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome