Abstract
Mortality for emergency abdominal aortic aneurysm (AAA) repair remains high but results of specialist vascular surgeons are superior to those of general surgeons. A retrospective audit was performed on all patients undergoing emergency AAA repair over 53 months at one hospital to determine the necessity for a vascular specialist on-call rota. Patients were stratified into two groups, those treated by specialist vascular surgeons and those treated by general surgeons. There were 37 patients in the vascular surgeon group and 36 in the general surgeon group. There was no significant difference between the two groups when age, sex distribution, APACHE II score on admission, pre-operative delay and type of rupture were considered. The average operating time was 114.7 min in the vascular surgeon group and 111.9 min in the general surgeon group. Total blood transfusion requirements, and postoperative duration of ventilation, inotrope therapy and intensive treatment unit stay were similar in the two groups. Intra-operative, 30-day and cumulative hospital mortalities were 10.8% versus 8.3%, 32.4% versus 38.9% and 40.5% versus 38.9% in the vascular surgeon and general surgeon groups, respectively. The mortality figures compare favourably with other published series. As the results of the two groups were similar, there is currently no need for vascular surgeons to be routinely available for acute AAA surgery at our hospital.
Full text
PDF




Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Akkersdijk G. J., van der Graaf Y., van Bockel J. H., de Vries A. C., Eikelboom B. C. Mortality rates associated with operative treatment of infrarenal abdominal aortic aneurysm in The Netherlands. Br J Surg. 1994 May;81(5):706–709. doi: 10.1002/bjs.1800810526. [DOI] [PubMed] [Google Scholar]
- Bengtsson H., Bergqvist D. Ruptured abdominal aortic aneurysm: a population-based study. J Vasc Surg. 1993 Jul;18(1):74–80. doi: 10.1067/mva.1993.42107. [DOI] [PubMed] [Google Scholar]
- Berridge D. C., Chamberlain J., Guy A. J., Lambert D. Prospective audit of abdominal aortic aneurysm surgery in the northern region from 1988 to 1992. Northern Vascular Surgeons Group. Br J Surg. 1995 Jul;82(7):906–910. doi: 10.1002/bjs.1800820716. [DOI] [PubMed] [Google Scholar]
- Bradbury A. W., Makhdoomi K. R., Adam D. J., Murie J. A., Jenkins A. M., Ruckley C. V. Twelve-year experience of the management of ruptured abdominal aortic aneurysm. Br J Surg. 1997 Dec;84(12):1705–1707. [PubMed] [Google Scholar]
- Burke P. M., Jr, Sannella N. A. Ruptured abdominal aortic aneurysm: a community experience. Cardiovasc Surg. 1993 Jun;1(3):239–242. [PubMed] [Google Scholar]
- Chen J. C., Hildebrand H. D., Salvian A. J., Taylor D. C., Strandberg S., Myckatyn T. M., Hsiang Y. N. Predictors of death in nonruptured and ruptured abdominal aortic aneurysms. J Vasc Surg. 1996 Oct;24(4):614–623. doi: 10.1016/s0741-5214(96)70077-0. [DOI] [PubMed] [Google Scholar]
- Farooq M. M., Freischlag J. A., Seabrook G. R., Moon M. R., Aprahamian C., Towne J. B. Effect of the duration of symptoms, transport time, and length of emergency room stay on morbidity and mortality in patients with ruptured abdominal aortic aneurysms. Surgery. 1996 Jan;119(1):9–14. doi: 10.1016/s0039-6060(96)80206-6. [DOI] [PubMed] [Google Scholar]
- Ingoldby C. J., Wujanto R., Mitchell J. E. Impact of vascular surgery on community mortality from ruptured aortic aneurysms. Br J Surg. 1986 Jul;73(7):551–553. doi: 10.1002/bjs.1800730711. [DOI] [PubMed] [Google Scholar]
- Johansen K., Kohler T. R., Nicholls S. C., Zierler R. E., Clowes A. W., Kazmers A. Ruptured abdominal aortic aneurysm: the Harborview experience. J Vasc Surg. 1991 Feb;13(2):240–247. [PubMed] [Google Scholar]
- Knaus W. A., Draper E. A., Wagner D. P., Zimmerman J. E. APACHE II: a severity of disease classification system. Crit Care Med. 1985 Oct;13(10):818–829. [PubMed] [Google Scholar]
- Meddings R. N., McCormick J. S., Mannam G. C. Abdominal aortic aneurysm in south-west Scotland. J R Coll Surg Edinb. 1991 Feb;36(1):6–10. [PubMed] [Google Scholar]
- Ouriel K., Geary K., Green R. M., Fiore W., Geary J. E., DeWeese J. A. Factors determining survival after ruptured aortic aneurysm: the hospital, the surgeon, and the patient. J Vasc Surg. 1990 Apr;11(4):493–496. doi: 10.1067/mva.1990.18639. [DOI] [PubMed] [Google Scholar]
- Rutledge R., Oller D. W., Meyer A. A., Johnson G. J., Jr A statewide, population-based time-series analysis of the outcome of ruptured abdominal aortic aneurysm. Ann Surg. 1996 May;223(5):492–505. doi: 10.1097/00000658-199605000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Scott A., Baillie C. T., Sutton G. L., Smith A., Bowyer R. C. Audit of 200 consecutive aortic aneurysm repairs carried out by a single surgeon in a district hospital: results of surgery and factors affecting outcome. Ann R Coll Surg Engl. 1992 May;74(3):205–211. [PMC free article] [PubMed] [Google Scholar]
