Outcomes of regional transfers of ruptured abdominal aortic aneurysm in a UK vascular network

Abstract

INTRODUCTION Rupture of abdominal aortic aneurysm is a surgical emergency. In order to improve operative outcomes, vascular services have been centralised in the United Kingdom. This means that a patient may present to a hospital with a ruptured aneurysm, but require transfer to a vascular centre for definitive treatment. METHODS This retrospective cohort study identified patients who underwent surgery for ruptured abdominal aortic aneurysm in a tertiary vascular centre over a 2-year period. Data on demographics and originating unit were recorded. Outcomes assessed included 30-day mortality, operative mortality and postoperative morbidity. RESULTS We identified 70 patients who underwent surgery for ruptured abdominal aortic aneurysm in the 2-year period; 36 presented directly to the vascular unit (VU), 14 to referral unit 1 (RU1) and 20 to referral unit 2 (RU2); 30-day mortality rates were 27.7% (VU), 35.5% (RU1) and 30.0% (RU2), respectively. There was no statistical difference in mortality between units. Postoperative complications were seen in 35.9% of VU patients, 78.6% of RU1 patients and 70% of RU2 patients. This was statistically significant between VU and RU1 (P = 0.006) and VU and RU2 (P = 0.02). Direct operative complications were seen in 9 patients, gastrointestinal complications in 9, limb complications in 6 and systemic complications in 40. CONCLUSION This study found that site of presentation does not affect mortality but is associated with increased morbidity. This is a complex issue, which will require a prospective multicentre study to investigate further.