Effect of Presurgical Time and Interfacility Transfer on Mortality in Patients with Ruptured Abdominal Aortic...

For patients with ruptured abdominal aortic aneurysm (rAAA), rapid transfer to a vascular centre and evaluation for endovascular repair is recommended. The aim of this study was to evaluate the effect of presurgical time and interfacility transfer on mortality in patients with rAAA.

This was a population based cohort study of consecutive patients admitted alive with rAAA in the Central Norway Regional Health Authority (2012 - 2022). Patient trajectories from symptom onset to arrival in the emergency department (prehospital time) were noted for all patients, and total presurgical time from symptom onset to start of surgery was noted for surgical patients. The impact of presurgical time and interfacility transfer on outcomes was evaluated, as well as reasons for palliation and outcomes after open and endovascular repair.

Of 315 patients, 135 (42.9%) received palliative care and 180 (57.1%) underwent surgery. Overall thirty day mortality was 59.0%. In operated patients, thirty and ninety day mortality rates were 31.7% and 36.1%. Of 180 surgical patients, 73 (40.6%) had interfacility transfer prior to repair, no deaths occurred during interfacility transfer, and thirty and ninety day mortality rates did not differ between transferred patients and those directly admitted to a vascular centre (32% vs. 32%, p = 1.0; 38% vs. 35%, p = .75). Longer presurgical time was associated with haemodynamic stability at presentation, while no increase in mortality was observed with delayed intervention. Endovascular repair had lower thirty and ninety day mortality rates compared with open surgery (10% vs. 37.9%, p <.001; 18% vs. 41.4%, p = .005).

In a healthcare region with considerable transfer distances, most patients with rAAA reaching hospital alive were sufficiently stable to undergo interfacility transfer and evaluation for endovascular repair. The results argue against using a fixed time threshold when deciding transfer to a vascular care centre. Safe transfer protocols and maximising access to endovascular repair should be the focus.