Community and hospital outcome from ruptured abdominal aortic aneurysm within the catchment area of a regional vascular surgical service

Objective: The objective of this study was to examine patterns of referral, management, and outcome of patients with ruptured abdominal aortic aneurys m (RAAA) within the catchment area of this regional vascular unit (RW). Methods: Referral, management, and outcome data regarding 972 consecutive p atients admitted to the hospital or certified deceased in the community bec ause of RAAA between January 1, 1989, and December 31, 1995, were retrieved from prospectively gathered computerized national and local databases. Results: Of 381 (39.2%) patients admitted to this unit, 316 (82.9%) underwe nt surgery, and of those, 188 (59.5%) survived. There was no significant di fference in overall mortality between patients who were admitted directly t o this unit (152 of 310, 49%) and those who were transferred from elsewhere (41 of 71, 58%). Surgical patients traveled significantly farther to the R W than nonsurgical patients (P <.001), but there was no significant differe nce in traveling distance between surgical patients who survived and those who did not. Of 372 (38%) patients who were admitted to other units and not transferred, 24 (6.4%) underwent surgery and 14 (3.8%) survived. Of 972 pa tients, the overall community mortality from RAAA was 770 (79%). Conclusion: Transferring patients from outlying units did not appear to pre judice operative outcome in this RW. However, less than half of all RAAA pa tients were transferred, and only a small minority of those not transferred underwent surgery. Although the overall community mortality from RAAA was similar to that reported in earlier studies from other regions and countrie s where centralization has not occurred, centralization of vascular surgica l services may be associated with an inappropriately low operation and surv ival rate for those patients who are not transferred to the regional center . The effect of centralization on the community outcome of emergent vascula r surgical conditions requires further investigation.