title: Effect of patient transfer on outcomes after open repair of ruptured abdominal aortic aneurysms.
abstract: Patients with ruptured abdominal aortic aneurysms (RAAAs) benefit from treatment in high-volume facilities. This study explored the effect of patient transfer on outcomes and the relationship between hemodynamic status and mortality. We performed a retrospective review of 83 consecutive patients who had open repair for RAAA at a single tertiary facility. The patients were divided into two groups based on arrival in the local emergency department, "local" (n = 44) versus "transfer" (n = 39) from an outside institution, and into three categories of hemodynamic status: (a) no obtainable blood pressure, "pulseless"; (b) requiring vasopressor support, "pressors"; and (c) no vasopressor support, "no pressors." Thirty-day mortality was 21.4%. There was no difference in mortality between the local (18.2%) and transfer (25.6%) patients (p = .41). There were no deaths during transfer. There was no difference in the hemodynamic status of the transfer versus the local group (p = .34). The mortality by category was pulseless, 100% (3 of 3); pressors, 71.4% (10 of 14); and no pressors, 7.6% (5 of 66) (p < .0001). Actuarial survival was 66%, 64%, and 62% at 1, 3, and 5 years, respectively. Patient transfer does not adversely affect mortality after RAAA repair. Patients without a palpable pulse and those requiring hemodynamic support have a significantly higher mortality.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center, Memorial Hermann Heart and Vascular Institute, Houston, TX, USA. Ali.Azizzadeh@uth.tmc.edu
authors.forename: Ali
authors.initials: A
authors.lastname: Azizzadeh
authors.forename: Charles C
authors.initials: CC
authors.lastname: Miller
authors.forename: Martin A
authors.initials: MA
authors.lastname: Villa
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Estrera
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Coogan
authors.forename: Sean T
authors.initials: ST
authors.lastname: Meiner
authors.forename: Hazim J
authors.initials: HJ
authors.lastname: Safi