VS03 *DOES “ON‐SITE” VASCULAR SURGERY IMPROVE RUPTURED AAA SURVIVAL?

Abstract

Eastern Health encompasses three major emergency departments but only one is linked to an on‐site vascular surgical service. All ruptured AAAs presenting at the other two sites are transferred for intervention. All patients who presented at any site with a DRG coded diagnosis of ruptured AAA from 2002 to 2008 are included. Thus, in contrast to many other studies, all patients are included, not just those who underwent operation. 101 patients were identified. 68 patients presented to the hospital with an onsite vascular service (group A) and 33 presented at sites without a vascular service (Group B). The average age (Group A = 79.4 years and Group B = 76.0 years) and the male predominance, 73% vs. 82% were not statistically different. The decision not to operate was made in 30% of group A and 33% of group B patients (p > 0.05). All of these patients died. The operative mortality of both groups was 34% and 32% and the overall mortality of patients presenting with ruptured AAA was 54% and 55%. The time in ICU and total length of stay of both groups was not different. Despite the same patient outcomes, the time between presentation and operation was different (median time group A = 92 min, group B = 239 min, p < 0.01). These results indicate that the significant difference in time to operation between the two groups did not influence patient outcome, nor did the lack of an “on‐site” vascular service lead to selective intervention. The development of vascular services at each site is not warranted for the purpose of treating ruptured abdominal aneurysms. It is not possible to extrapolate these results to situations where longer transfer times are involved but it does suggest that further studies are warranted.