title: Does the establishment of a Vascular Unit reduce the prevalence of ruptured aortic aneurysms?
abstract: OBJECTIVE
  The aim of this study was to assess the effect of a specialised Vascular Unit upon the prevalence of ruptured aortic aneurysms in the same population catchments' area and associated mortality rates.
  
  
  METHODS
  
  
  
  METHODS
  prospective computerised data collection from 1997 to today, retrospective from 1990-1996.
  
  
  METHODS
  108 aneurysms were operated upon from 1990-1996, compared to 317 from 1997 to Aug 2002.
  
  
  METHODS
  statistical analysis was done using SPSS statistics with Kaplan Meier life table curves and compared by the log rank test while the Mann Whitney test was used for comparison of mortality.
  
  
  RESULTS
  The median values for ruptured aneurysms per year were 5 for the early period, compared to 10 for the recent years, while the median values for both urgent and ruptured were 7 and 18.5 cases annually, respectively. The number of scheduled procedures increased by 500% in the second period, with median values of 7 and 36.5, respectively. In-hospital mortality according to category was 21% for scheduled, 31% for urgent and 69% for ruptured aneurysms in the early period, compared to 3.7%, 16% and 29% respectively, following the establishment of the Vascular Unit.
  
  
  CONCLUSIONS
  Despite the five-fold increase in the total number of aortic aneurysm repairs (as expected), the number of ruptured aneurysms operated upon increased as well. There was just a trend for a reduction in the absolute numbers of ruptured aneurysms operated upon in the last 2 years. Mortality, on the other hand, decreased dramatically in all categories, with the overall 30-day mortality decreasing more than four-fold, from 40% to 9.3%, while the respective mortalities according to the category of intervention were 3.7% vs 21% for scheduled, 16% vs 35% for urgent and 29% vs 69% for ruptured aneurysms, with a P value of less than 0.01. However, there was no difference in the numbers of patients with ruptured aneurysm reaching the hospital (operated or not) between the two periods (median values of 11 and 10.5 annually). The presence of a Vascular Unit, although it achieves dramatically better results, is not associated with a reduction in the number of emergency proceduresaeat least in the intermediate termaedespite an expansion in the indications for surgery, increased awareness and prompt referrals (centralisation).
authors.affiliation: Department of Vascular Surgery, Broomfield Hospital, Broomfield, Chelmsford, UK.
authors.forename: Y P
authors.initials: YP
authors.lastname: Panayiotopoulos
authors.forename: A
authors.initials: A
authors.lastname: Liamis
authors.forename: I
authors.initials: I
authors.lastname: Prionidis
authors.forename: J
authors.initials: J
authors.lastname: Mathai
authors.forename: A
authors.initials: A
authors.lastname: Sort
authors.forename: C
authors.initials: C
authors.lastname: McCartney
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000453:epidemiology* / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology* / Q000601:surgery; D004739:England / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013503:Surgery Department, Hospital / Q000458:organization & administration*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000639:trends*