CHANGES IN REFERRAL PRACTICE, WORKLOAD, AND OPERATIVE MORTALITY AFTERESTABLISHMENT OF AN ENDOVASCULAR ABDOMINAL AORTIC-ANEURYSM PROGRAM

Purpose: To determine the change in referral practice following establ ishment of an endovascular abdominal aortic aneurysm (AAA) program. Me thods: A prospective audit of all elective admissions for AAA was esta blished in January 1994 at the initiation of an endovascular AAA progr am. A comparison was made between this cohort and the elective AAA rep airs performed between 1981 and 1993. Results: Since January 1994, 213 AAA patients (177 men; median age 73 years, range 54 to 88) have been referred for potential endovascular aneurysm repair. To date, 142 pat ients have undergone elective surgery (41 endovascular and 101 convent ional). Between 1981 and 1993, 304 patients (255 men; median age 69 ye a rs, range 45 to 86) had elective aneurysm repair. Comparison of the two time periods has revealed significant increases in the number of t ertiary referrals (41.8% versus 9.5%, p < 0.01), annual operations (50 versus 23, p < 0.05), and overall mortality (12% versus 6.7%, p < 0.0 5), the latter attended by a significant increase in cardiorespiratory comorbidity. Conclusions: The higher elective AAA mortality rate sinc e the establish ment of an endovascular program reflects a change in r eferral practice and may be directly attributable to an increase in th e number of high-risk patients. An endovascular AAA program has clinic al and financial implications for the hospital concerned.