Revista portuguesa de cirurgia cardio-toracica e vascular : orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular · 2017
Influence of interhospital transfer on outcomes of symptomatic and ruptured abdominal aortic aneurysms.
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Camacho Nelson, Bastos Gonçalves Frederico, Rodrigues Gonçalo, Abreu Rodolfo, Ferreira Rita, Catarino Joana, Correia Ricardo, Ferreira Maria Emília
Аннотация
UNLABELLED: Objetive: Evaluate the influence of the geographic location of patients with symptomatic abdominal aortic aneurysms (AAA) or ruptured AAA (rAAA), on mortality.
METHODS: Retrospective review of all cases of symptomatic AAA and rAAA submitted to surgery in a tertiary institution, between January 2011 and August 2017. The main outcome was in-hospital mortality. Secondary outcomes were admission to intensive care unit (ICU), length of ICU and hospital stay, type of repair and anesthesia and weekend presentation. Data was submitted to univariable analysis and logistic regression. Statistical significance was considered if the p value was <0.05.
RESULTS: 135 patients were admitted with the diagnosis of symptomatic or rAAA and submitted to surgery, 83 (61.5%) by endovascular repair and 52 (38.5%) by open repair, 30.4% with local anesthesia and sedation. 92 patients (68.1%) were transferred from other hospitals, with a mean distance of 113±88 km. Subgroup analysis revealed that there were no significant differences between transferred and not transferred patients' groups concerning main outcome (31.5% vs 34.9%, p=0.35), baseline characteristics (age and gender), type of surgery and anesthesia, weekend presentation, ICU admission, length of ICU and hospital stay. Logistic regression analysis revealed that the variables associated with mortality were female gender (odds ratio [OR] 2.28; 95% confidence interval [CI] 1.40-3.70; p<0.01), open repair (OR 2.79; 95% CI 1.68-4.63; p<0.01) and general anesthesia (OR 9.16; 95% CI 2.33-36.06; p<0.01).
CONCLUSION: Our study revealed that interhospital transfer of patients for urgent repair of AAA was not associated with an increased mortality.
METHODS: Retrospective review of all cases of symptomatic AAA and rAAA submitted to surgery in a tertiary institution, between January 2011 and August 2017. The main outcome was in-hospital mortality. Secondary outcomes were admission to intensive care unit (ICU), length of ICU and hospital stay, type of repair and anesthesia and weekend presentation. Data was submitted to univariable analysis and logistic regression. Statistical significance was considered if the p value was <0.05.
RESULTS: 135 patients were admitted with the diagnosis of symptomatic or rAAA and submitted to surgery, 83 (61.5%) by endovascular repair and 52 (38.5%) by open repair, 30.4% with local anesthesia and sedation. 92 patients (68.1%) were transferred from other hospitals, with a mean distance of 113±88 km. Subgroup analysis revealed that there were no significant differences between transferred and not transferred patients' groups concerning main outcome (31.5% vs 34.9%, p=0.35), baseline characteristics (age and gender), type of surgery and anesthesia, weekend presentation, ICU admission, length of ICU and hospital stay. Logistic regression analysis revealed that the variables associated with mortality were female gender (odds ratio [OR] 2.28; 95% confidence interval [CI] 1.40-3.70; p<0.01), open repair (OR 2.79; 95% CI 1.68-4.63; p<0.01) and general anesthesia (OR 9.16; 95% CI 2.33-36.06; p<0.01).
CONCLUSION: Our study revealed that interhospital transfer of patients for urgent repair of AAA was not associated with an increased mortality.