title: Ruptured abdominal aortic aneurysm: does trauma center designation affect outcome?
abstract: Ruptured abdominal aortic aneurysm (RAAA) continues to be a major cause of mortality in the United States. Rapid diagnosis and uncomplicated surgical repair remain paramount to improving survival in this population. We proposed that the addition of an organized trauma service and subsequent improved management of critically ill patients who present with RAAA would positively impact overall mortality. A retrospective analysis was performed on all patients treated for RAAA at Santa Barbara Cottage Hospital for the years 1985-2004. Patients treated before level II trauma center designation (1985-1999) were compared to those treated after the trauma center was instituted. A total of 76 patients were included in this analysis. The two groups were similar with regard to demographics. However, significant decreases in transport time from the emergency department to the operating room and overall 30-day mortality were seen in patients after the trauma center designation. This designation also led to an increase in the number of cases performed per year, centralizing the treatment for these critically ill patients. Institution of a well-prepared and organized service, such as trauma, improved the outcome for patients treated with RAAA, with a particular benefit in the unstable patient.
authors.affiliation: Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
authors.forename: Farida
authors.initials: F
authors.lastname: Bounoua
authors.forename: Rob
authors.initials: R
authors.lastname: Schuster
authors.forename: Prabhjot
authors.initials: P
authors.lastname: Grewal
authors.forename: Kenneth
authors.initials: K
authors.lastname: Waxman
authors.forename: Paul
authors.initials: P
authors.lastname: Cisek
mesh_terms: D000068:Accreditation; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure; D002140:California / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006764:Hospitals, Community / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D010348:Patient Care Team / Q000458:organization & administration; D010360:Patient Transfer / Q000458:organization & administration; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000458:organization & administration* / Q000706:statistics & numerical data