G. Metzger1, T. Yoo1, D. Chou1, M. J. Haurani1, J. Starr1 1Ohio State University,Vascular Diseases And Surgery,Columbus, OH, USA
Introduction: ~~: Ruptured abdominal aortic aneurysm (rAAA) is the 13th leading cause of death in the United States, responsible for approximately 15,000 deaths per year. The prognosis of untreated rAAA is dismal, with an overall mortality of 90%, with immediate diagnosis and surgical intervention as the only modality for survival. We hypothesize that the time to intervention is a significant factor in determining survival.
Methods: ~~We retrospectively reviewed all patients in a single institution from 2012-2017 with diagnosis of ruptured abdominal or type IV thoraco-abdominal aortic aneurysm presenting to the Emergency Department (ED) that underwent emergent attempted open or endovascular repair. Patients that did not travel straight from the ED to the OR were excluded. Records were retrospectively reviewed to determine hemodynamic status on initial presentation, the need for imaging, time from ED (arrival or initial evaluation??)to incision, and type of repair. The primary outcome was 30-day mortality.
Results:~~101 patients with aortic emergency were reviewed of which 32 met criteria. 30-day mortality was 28.1% (n=9). Time from arrival to incision ranged from 36 to 269 minutes (median=94 min, STD±65.7 min). There was no difference in mortality between open (n=19) and endovascular intervention (n=13). There was increased mortality in patients with hemodynamic instability before intervention (46.2% vs. 16.7%, p=0.10). In patients who underwent intervention within 60 minutes of arrival, there were no deaths, even in those with hemodynamic instability. Increasing time-to-intervention increased risk of death, especially in unstable patients (Figure 1, 0% mortality within 60 minutes, 57% within 61-120 min, and 100% mortality over 120+ min).
Conclusion:~~Similar to trauma reports, time-to-operation appears to be a significant factor predicting survival, especially in unstable patients. We have identified intervention within one hour as a possible metric for quality improvement, with the aim of streamlining an expedited, team-based, multi-disciplinary approach to improve survival.
