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Ruptured aortic aneurysm: the decision not to operate
1Department of Surgery, Royal Devon and Exeter Hospital, Wonford.
Annals of the Royal College of Surgeons of England
|July 31, 1998
Summary
Surgeons often decline operating on ruptured abdominal aortic aneurysms (RAAA) due to patient factors. Severe neurological disease and advanced age significantly influence these decisions, impacting RAAA case selection.
Area of Science:
- Vascular Surgery
- Surgical Decision-Making
- Public Health
Background:
- Published criteria exist for predicting survival after ruptured abdominal aortic aneurysm (RAAA) repair.
- However, factors influencing surgeons' decisions *not* to operate on RAAA patients are not well understood.
Purpose of the Study:
- To investigate the practice patterns and influencing factors for surgeons deciding against RAAA repair.
Main Methods:
- A questionnaire was distributed to 404 members of the Vascular Surgical Society of Great Britain and Ireland.
- Response rate was 81% (323 surgeons), assessing factors influencing the decision not to operate.
Main Results:
- 97% of responding surgeons reported declining surgery for selected RAAA patients.
- Age over 80 (77%) and severe neurological disease (75%) were major deterrents. Comorbidities like cardiac, pulmonary, or renal disease (74% when combined) also influenced decisions.
- Factors such as cardiac arrest (85%), loss of consciousness (74%), prolonged hypotension (73%), and need for long-term nursing care (87%) were highly influential.
Conclusions:
- Surgeons' decisions not to operate on RAAA are influenced by patient age, severe comorbidities (especially neurological), and physiological instability.
- These findings are crucial for refining case selection criteria and informing the debate on RAAA management.