title: Comparison of long-term mortality after ruptured abdominal aortic aneurysm in England and Sweden.
abstract: BACKGROUND
  Concern has been raised regarding international discrepancies in perioperative mortality after repair of ruptured abdominal aortic aneurysm (rAAA). The variation in in-hospital mortality is difficult to interpret, owing to international differences in discharge strategies. This study compared 90-day and 5-year mortality in patients who had a rAAA in England and Sweden.
  
  
  METHODS
  Patients undergoing rAAA repair were identified from English Hospital Episode Statistics and the Swedish Vascular Registry (Swedvasc) between 2003 and 2012. Ninety-day and 5-year mortality were compared after matching for age and sex. Within-country analyses examined the impact of co-morbidity, teaching hospital status or hospital annual caseload, adjusted with causal inference techniques.
  
  
  RESULTS
  Some 12 467 patients underwent rAAA repair in England, of whom 83.2 per cent were men; the median (i.q.r.) age was 75 (70-80) years. A total of 2829 Swedish patients underwent rAAA repair, of whom 81.3 per cent were men; their median (i.q.r.) age was 75 (69-80) years. The 90-day mortality rate was worse in England (44.0 per cent versus 33.4 per cent in Sweden; P < 0.001), as was 5-year mortality (freedom from mortality 38.6 versus 46.3 per cent respectively; P < 0.001). In England, lower mortality was seen in teaching hospitals with larger bed capacity, higher annual caseloads and greater use of endovascular aneurysm repair (EVAR). In Sweden, lower mortality was associated with EVAR, high annual caseload, or surgery on weekdays compared with weekends.
  
  
  CONCLUSIONS
  Short- and long-term mortality after rAAA repair was higher in England. In both countries, mortality was lowest in centres performing greater numbers of AAA repairs per annum, and more EVAR procedures.
authors.affiliation: St George's Vascular Institute, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Karthikesalingam
authors.affiliation: Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Wanhainen
authors.affiliation: St George's Vascular Institute, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Holt
authors.affiliation: St George's Vascular Institute, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Vidal-Diez
authors.affiliation: St George's Vascular Institute, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: J R W
authors.initials: JR
authors.lastname: Brownrigg
authors.affiliation: Department of Mathematical Sciences, University of Southampton, Southampton, UK.
authors.forename: I
authors.initials: I
authors.lastname: Shpitser
authors.affiliation: Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Björck
authors.affiliation: St George's Vascular Institute, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
authors.affiliation: Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Mani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery; D001019:Aortic Rupture / Q000401:mortality* / Q000601:surgery; D057510:Endovascular Procedures / Q000379:methods*; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors