Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Karkos CD, Harkin DW, Giannakou A et al (2009) Mortality after endovascular repair of ruptured abdominal aortic aneurysms: a systematic review and meta-analysis. Arch Surg 144:770–778

    Article  PubMed  Google Scholar 

  2. Reimerink JJ, van der Laan MJ, Koelemay MJ et al (2013) Systematic review and meta-analysis of population-based mortality from ruptured abdominal aortic aneurysm. Br J Surg 100:1405–1413

    Article  PubMed  CAS  Google Scholar 

  3. Reite A, Soreide K, Ellingsen CL et al (2015) Epidemiology of ruptured abdominal aortic aneurysms in a well-defined Norwegian population with trends in incidence, intervention rate, and mortality. J Vasc Surg 61(5):1168–1174

    Article  PubMed  Google Scholar 

  4. Laine MT, Laukontaus SJ, Kantonen I et al (2016) Population-based study of ruptured abdominal aortic aneurysm. Br J Surg 103:1634–1639

    Article  PubMed  CAS  Google Scholar 

  5. von Elm E, Altman DG, Egger M et al (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457

    Article  Google Scholar 

  6. Chen JC, Hildebrand HD, Salvian AJ et al (1996) Predictors of death in nonruptured and ruptured abdominal aortic aneurysms. J Vasc Surg 24:614–620 (discussion 621–613)

    Article  PubMed  CAS  Google Scholar 

  7. Visser JJ, Williams M, Kievit J et al (2009) Prediction of 30-day mortality after endovascular repair or open surgery in patients with ruptured abdominal aortic aneurysms. J Vasc Surg 49:1093–1099

    Article  PubMed  Google Scholar 

  8. Tambyraja A, Murie J, Chalmers R (2007) Predictors of outcome after abdominal aortic aneurysm rupture: Edinburgh Ruptured Aneurysm Score. World J Surg 31:2243–2247. https://doi.org/10.1007/s00268-007-9181-5

    Article  PubMed  Google Scholar 

  9. Hardman DT, Fisher CM, Patel MI et al (1996) Ruptured abdominal aortic aneurysms: who should be offered surgery? J Vasc Surg 23:123–129

    Article  PubMed  CAS  Google Scholar 

  10. Greeven AP, Bouwman LH, Smeets HJ et al (2011) Outcome of patients with ruptured abdominal aortic aneurysm after cardiopulmonary resuscitation. Acta Chir Belg 111(78–8):2

    Google Scholar 

  11. Mell MW, Starnes BW, Kraiss LW et al (2017) Western Vascular Society guidelines for transfer of patients with ruptured abdominal aortic aneurysm. J Vasc Surg 65(603–60):8

    Google Scholar 

  12. Zommorodi S, Roy J, Steuer J et al (2016) High proportion of known abdominal aortic aneurysm in patients with rupture indicates surveillance deficiency. J Vasc Surg 64:949–955 e941

    Article  PubMed  Google Scholar 

  13. Ozdemir BA, Karthikesalingam A, Sinha S et al (2015) Association of hospital structures with mortality from ruptured abdominal aortic aneurysm. Br J Surg 102(516–52):4

    Google Scholar 

  14. Grootenboer N, van Sambeek MR, Arends LR et al (2010) Systematic review and meta-analysis of sex differences in outcome after intervention for abdominal aortic aneurysm. Br J Surg 97(1169–117):9

    Google Scholar 

  15. Hultgren R, Zommorodi S, Gambe M et al (2016) A majority of admitted patients with ruptured abdominal aortic aneurysm undergo and survive corrective treatment: a population-based retrospective cohort study. World J Surg 40:3080–3087. https://doi.org/10.1007/s00268-016-3705-9

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Mayer D, Aeschbacher S, Pfammatter T et al (2012) Complete replacement of open repair for ruptured abdominal aortic aneurysms by endovascular aneurysm repair: a two-center 14-year experience. Ann Surg 256:688–695 (discussion 695–686)

    Article  PubMed  CAS  Google Scholar 

  17. Reite A, Soreide K, Vetrhus M (2017) Comparing the accuracy of four prognostic scoring systems in patients operated on for ruptured abdominal aortic aneurysms. J Vasc Surg 65:609–615

    Article  PubMed  Google Scholar 

  18. Lamba S, Bonanni M, Courage CA et al (2013) When a patient declines curative care: management of a ruptured aortic aneurysm. West J Emerg Med 14:555–558

    Article  PubMed  PubMed Central  Google Scholar 

  19. Walker EM, Hopkinson BR, Makin GS (1983) Unoperated abdominal aortic aneurysm: presentation and natural history. Ann R Coll Surg Engl 65:311–313

    PubMed  PubMed Central  CAS  Google Scholar 

  20. Chaikof EL, Brewster DC, Dalman RL et al (2009) The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 50:S2–S49

    Article  PubMed  Google Scholar 

  21. Lloyd GM, Bown MJ, Norwood MG et al (2004) Feasibility of preoperative computer tomography in patients with ruptured abdominal aortic aneurysm: a time-to-death study in patients without operation. J Vasc Surg 39:788–791

    Article  PubMed  CAS  Google Scholar 

  22. van Beek SC, Vahl AC, Wisselink W et al (2015) Fate of patients unwilling or unsuitable to undergo surgical intervention for a ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 49:163–165

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Vascular Surgery Unit, Stavanger University Hospital, PO Box 8100, 4068, Stavanger, Norway

    Morten Vetrhus, Andreas Reite & Jørgen B. Vennesland

  2. Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway

    Kjetil Søreide

  3. Department of Clinical Medicine, University of Bergen, Bergen, Norway

    Kjetil Søreide

Authors
  1. Morten Vetrhus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andreas Reite
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jørgen B. Vennesland
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kjetil Søreide
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Morten Vetrhus.

Ethics declarations

Conflict of interest

No conflicts of interest for any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vetrhus, M., Reite, A., Vennesland, J.B. et al. Characteristics, Stratification and Time to Death in a Population-Based Cohort of Patients with Ruptured Abdominal Aortic Aneurysms Not Undergoing Surgery. World J Surg 42, 2269–2276 (2018). https://doi.org/10.1007/s00268-017-4445-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-017-4445-1

Search

Navigation