title: Decrease of mortality of ruptured abdominal aortic aneurysm after centralization and in-hospital quality improvement of vascular service.
abstract: Our aim was to determine whether organizational changes could improve the outcome after ruptured abdominal aortic aneurysm (RAAA). Regional centralization and quality improvement in the in-hospital chain of treatment of RAAA included strengthening of the emergency preparedness and better availability of postoperative intensive care. During the reorganization, all patients with RAAA were admitted to Helsinki University Central Hospital (HUCH) from Helsinki and Uusimaa district. RAAA patients in the hospital district of Helsinki and Uusimaa between 1996 and 2004 were identified. The study period was divided into three periods: I, control; II, change; and III, present. Of the total of 626 patients with RAAA, 352 (56%) were admitted to the HUCH, of whom 315 (90%) underwent surgery. During the study period, population-based mortality decreased from 77% to 56% (P < 0.001) and 90-day mortality, from 54% to 28% (P = 0.002). Operative 30-day mortality was 19% during the third period and lower than previously (P = 0.001). Our results seem to argue in favor of centralization of emergency vascular services with adequate manpower and operative expertise in the first line and with availability of closed-unit postoperative critical care to achieve better results as these measures were associated with a positive impact on survival.
authors.affiliation: Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland. sani.laukontaus@hus.fi
authors.forename: Sani Joanna
authors.initials: SJ
authors.lastname: Laukontaus
authors.forename: Pekka-Sakari
authors.initials: PS
authors.lastname: Aho
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
authors.forename: Anders
authors.initials: A
authors.lastname: Albäck
authors.forename: Ilkka
authors.initials: I
authors.lastname: Kantonen
authors.forename: Mikael
authors.initials: M
authors.lastname: Railo
authors.forename: Marja
authors.initials: M
authors.lastname: Hynninen
authors.forename: Mauri
authors.initials: M
authors.lastname: Lepäntalo
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality*; D001019:Aortic Rupture / Q000401:mortality*; D003422:Critical Care / Q000458:organization & administration / Q000592:standards; D003644:Death Certificates; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D005387:Finland / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000379:methods; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000458:organization & administration / Q000592:standards*; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000458:organization & administration / Q000592:standards*