title: Symptomatic abdominal aortic aneurysm repair: to wait or not to wait.
abstract: BACKGROUND
  In patients with a symptomatic abdominal aortic aneurysm (sAAA), acute intervention theoretically reduces rupture risk prior to surgery whereas delayed intervention provides surgery under optimised conditions. In the present study we evaluated differences in 30-day mortality in patients with a sAAA operated within 12 hours compared to patients who received treatment after 12 hours and who were optimized for surgery.
  
  
  METHODS
  All patients with a sAAA who were treated within one week after presentation were included in the analyses. The 30-day mortality rates of patients operated within 12 hours were compared to those operated after 12 hours, adjusted for type of operation and for all potential confounders.
  
  
  RESULTS
  Of the 89 included patients, 37 patients received surgery within 12 hours. In patients treated within 12 hours, 30-day mortality rate was 6 (16.2%) compared to 3 (5.8%) in patients treated after 12 hours (odds ratio 0.316; CI 0.074-1.358). When adjusted for type of operation and other confounders, odds ratios were 0.305 (CI 0.066-1.405) and 0.270 (CI 0.015-4.836), respectively.
  
  
  CONCLUSIONS
  In a substantial amount of patients with an alleged symptomatic AAA, delayed surgery with patient optimisation might be justified. However, specific criteria in order to select patients that might benefit from delayed surgery need further investigation.
authors.affiliation: Department of Surgery, Atrium Medical Centre Parkstad, Heerlen, The Netherlands - jantenbosch@gmail.com.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Ten Bosch
authors.forename: Sam W
authors.initials: SW
authors.lastname: Koning
authors.forename: Edith M
authors.initials: EM
authors.lastname: Willigendael
authors.forename: Marc R
authors.initials: MR
authors.lastname: VAN Sambeek
authors.forename: Rutger A
authors.initials: RA
authors.lastname: Stokmans
authors.forename: Martin H
authors.initials: MH
authors.lastname: Prins
authors.forename: Joep A
authors.initials: JA
authors.lastname: Teijink
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality