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Sachinder Singh Hans, MD; Raywin R. Huang, PhD

Arch Surg. 2003;138:898-901.

Hypotheses  The results of ruptured abdominal aortic aneurysm repairs from a solo community hospital–based practice are comparable to those reported from large university referral medical centers. Patients younger than 70 years, arriving in the emergency department with stable hemodynamics, and undergoing prompt operation have better outcome.

Design  A retrospective review from an ongoing vascular surgery registry.

Setting  Two midsized (300-bed) community hospitals. One hundred one consecutive patients with ruptured abdominal aortic aneurysms who were undergoing open surgical repair by a single surgeon (S.S.H.) during a 21-year period were reviewed.

Main Outcome Measures  Operative mortality; cardiac, pulmonary, renal, and gastrointestinal complications; and coagulation abnormalities were recorded. Iatrogenic complications and length of hospital stay were noted. Preoperative and intraoperative factors affecting mortality were studied.

Results  Fifty-three patients survived ruptured abdominal aortic aneurysm repair (operative mortality, 47.5%). A favorable outcome was observed in patients (1) younger than 70 years, (2) with a hematocrit of more than 35% at presentation, and (3) with emergency department to operating room times of less than 120 minutes. Increasing experience of the surgeon did not result in improved survival.

Conclusion  The results of ruptured abdominal aortic aneurysm repairs from community-based practice are comparable to those reported from university referral medical centers.

From the Department of Surgery, St John Macomb Hospital, Warren (Dr Hans), and William Beaumont Hospital Research Institute, Royal Oak (Dr Huang), Mich.

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