Characteristics, Stratification and Time to Death in a Population-Based Cohort of Patients with Ruptured Abdominal Aortic Aneurysms Not Undergoing Surgery

  • Morten Vetrhus
  • Andreas Reite
  • Jørgen B. Vennesland
  • Kjetil Søreide
Original Scientific Report
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Abstract

Background

The available literature on ruptured abdominal aortic aneurysms (rAAA) centers on survival after operation and commonly, reasons why some patients do not undergo surgery are not addressed. The aim of the present study is to examine, in a population-based cohort, the characteristics, stratification and time to death of patients admitted to hospital, but not undergoing operation for rAAA.

Methods

A retrospective, single-center study. All patients admitted to Stavanger University Hospital from the primary catchment area with rAAA on admission or in-hospital from 2000 to 2014 were included.

Results

Altogether 214 patients with rAAA were identified; 57 (27%) patients did not undergo surgery. The proportion of women was significantly higher (37 vs. 14%; p < .001) in patients not having surgery. The reasons for not undergoing operation were patient ‘not fit for surgery’ (30%), ‘dying or agonal’ at time of diagnosis (26%), ‘did not want operation’ (21%) and ‘diagnosed at autopsy’ (23%). Of the non-operated patients, 45 had rAAA on arrival to hospital, 12 had in-hospital rupture and 21 patients had previously been diagnosed with an abdominal aortic aneurysm. Non-operative treatment was uniformly fatal. The 45 patients with rAAA on arrival were scored using four scoring systems, the predicted mortality varied widely, and the median time from admission to death was 7.4 h (range 0–1337).

Conclusion

In about half of patients, a decision not to operate was made by the consultant vascular surgeon or the patient. In the subgroup of patients not diagnosed until autopsy or having an in-hospital rupture, an earlier diagnosis might have altered the outcome.

Notes

Compliance with ethical standards

Conflict of interest

No conflicts of interest for any of the authors.

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Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Morten Vetrhus
    • 1
  • Andreas Reite
    • 1
  • Jørgen B. Vennesland
    • 1
  • Kjetil Søreide
    • 2
    • 3
  1. 1.Department of Surgery, Vascular Surgery UnitStavanger University HospitalStavangerNorway
  2. 2.Department of Gastrointestinal SurgeryStavanger University HospitalStavangerNorway
  3. 3.Department of Clinical MedicineUniversity of BergenBergenNorway

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