Document Detail


Does the establishment of a Vascular Unit reduce the prevalence of ruptured aortic aneurysms?
MedLine Citation:
PMID:  17622204     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: The aim of this study was to assess the effect of a specialised Vascular Unit upon the prevalence of ruptured aortic aneurysms in the same population catchments' area and associated mortality rates.
METHODS:
SETTING: prospective computerised data collection from 1997 to today, retrospective from 1990-1996.
SUBJECTS: 108 aneurysms were operated upon from 1990-1996, compared to 317 from 1997 to Aug 2002.
MAIN OUTCOME MEASURES: statistical analysis was done using SPSS statistics with Kaplan Meier life table curves and compared by the log rank test while the Mann Whitney test was used for comparison of mortality.
RESULTS: The median values for ruptured aneurysms per year were 5 for the early period, compared to 10 for the recent years, while the median values for both urgent and ruptured were 7 and 18.5 cases annually, respectively. The number of scheduled procedures increased by 500% in the second period, with median values of 7 and 36.5, respectively. In-hospital mortality according to category was 21% for scheduled, 31% for urgent and 69% for ruptured aneurysms in the early period, compared to 3.7%, 16% and 29% respectively, following the establishment of the Vascular Unit.
CONCLUSION: Despite the five-fold increase in the total number of aortic aneurysm repairs (as expected), the number of ruptured aneurysms operated upon increased as well. There was just a trend for a reduction in the absolute numbers of ruptured aneurysms operated upon in the last 2 years. Mortality, on the other hand, decreased dramatically in all categories, with the overall 30-day mortality decreasing more than four-fold, from 40% to 9.3%, while the respective mortalities according to the category of intervention were 3.7% vs 21% for scheduled, 16% vs 35% for urgent and 29% vs 69% for ruptured aneurysms, with a P value of less than 0.01. However, there was no difference in the numbers of patients with ruptured aneurysm reaching the hospital (operated or not) between the two periods (median values of 11 and 10.5 annually). The presence of a Vascular Unit, although it achieves dramatically better results, is not associated with a reduction in the number of emergency proceduresaeat least in the intermediate termaedespite an expansion in the indications for surgery, increased awareness and prompt referrals (centralisation).
Authors:
Y P Panayiotopoulos; A Liamis; I Prionidis; J Mathai; A Sort; C McCartney
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  International angiology : a journal of the International Union of Angiology     Volume:  26     ISSN:  0392-9590     ISO Abbreviation:  Int Angiol     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-07-11     Completed Date:  2007-12-11     Revised Date:  2014-07-29    
Medline Journal Info:
Nlm Unique ID:  8402693     Medline TA:  Int Angiol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  233-8     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aneurysm, Ruptured / epidemiology*,  surgery
Aortic Aneurysm, Abdominal / epidemiology*,  surgery
England / epidemiology
Follow-Up Studies
Humans
Middle Aged
Prevalence
Prospective Studies
Retrospective Studies
Risk Factors
Surgery Department, Hospital / organization & administration*
Survival Rate / trends
Time Factors
Vascular Surgical Procedures / trends*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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