title: Mortality outcomes of ruptured abdominal aortic aneurysms and rural presentation.
abstract: OBJECTIVE
  Centralisation of vascular surgery services has coincided with a move towards endovascular repair of ruptured abdominal aortic aneurysms with the goal to improve patient outcomes. The aim of this study was to assess the effect of rural presentation and transfer times on survival from ruptured abdominal aortic aneurysm.
  
  
  METHODS
  A retrospective review.
  
  
  METHODS
  All patients presenting with ruptured abdominal aortic aneurysm to public hospitals in Tasmania between July 2006 and April 2013.
  
  
  METHODS
  Demographic data, Glasgow aneurysm score, Hardman index, transfer times, operative technique and 30-day mortality were collected from medical records.
  
  
  RESULTS
  Over the study period 127 patients presented to public hospitals in Tasmania with ruptured abdominal aortic aneurysm. A total of 27 presented to north west hospitals where no vascular surgery service is provided (NWRH), 23 to a northern hospital where an intermittent vascular surgery service is provided (LGH) and 77 to the state tertiary vascular surgery service (RHH). Of these, 4 (14.8%) died at NWRH, 6 (26.1%) died at LGH and 43 (55.8%) died at RHH without operation. Of the 35 patients transferred from NWRH and LGH to RHH, 5 died without operation. Median time from presentation to theatre at RHH if transferred from NWRH was 6.25 hours, from the LGH 4.75 hours, compared to 2.75 hours when presenting directly to RHH. Open repair was performed in 41 patients and endovascular repair in 23 patients. Overall 30-day mortality in those treated at RHH was 26.6% (39.0% for open repair, 4.3% for endovascular repair). Mortality for intended operative patients initially presenting to non-RHH hospitals was 33.3% vs. 32.3% for those initially presenting to RHH. p Value 0.93.
  
  
  CONCLUSIONS
  There was no clinical or statistical disadvantage to rural presentation and transfer for patients presenting with ruptured abdominal aortic aneurysm in Tasmania. Endovascular repair has a role despite long transfer times.
authors.affiliation: Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Munday
authors.affiliation: Division of Surgery, University of Tasmania, Hobart, Tasmania, Australia stuart.walker@dhhs.tas.gov.au.
authors.forename: Stuart
authors.initials: S
authors.lastname: Walker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D002497:Centralized Hospital Services / Q000458:organization & administration*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006779:Hospitals, Public / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000458:organization & administration*; D012189:Retrospective Studies; D012307:Risk Factors; D019035:Rural Health Services / Q000458:organization & administration*; D013648:Tasmania / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000458:organization & administration; D013997:Time Factors; D061665:Time-to-Treatment / Q000458:organization & administration*; D014187:Transportation of Patients / Q000458:organization & administration; D016896:Treatment Outcome
keywords: Aortic aneurysm; abdominal; aortic rupture; demography; endovascular procedures; rural population