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Population-based survival rate with a one- or two-stop referral pattern for patients with ruptured abdominal aortic aneurysms
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
2013 (English)In: International Journal of Angiology, ISSN 0392-9590, E-ISSN 1827-1839, Vol. 32, no 5, 492-500 p.Article in journal (Refereed) Published
Abstract [en]

AIM:

Is there a difference in the population-based survival rate for patients with ruptured abdominal aortic aneurysms (rAAA), handled by a "one-stop" or a "two-stop" referral pattern?

METHODS:

Ten regions in Sweden were identified where clear-cut "one-stop" or "two-stop" referral-patterns prevailed. From the Swedvasc Registry we identified 849 patients operated on for rAAA, 1987 to 2004, living in any of these ten regions, and related the number of survivors to the whole population served by each hospital.

RESULTS:

The population-based survival rate was 14% lower for patients following a "two-stop" compared to a "one-stop" referral pattern (P=0.084). For the group 65-74 years-of-age the difference was significant (P=0.021), but no corresponding effect was seen regarding operative mortality rate or sex.

CONCLUSION:

Compared to a "one-stop" referral pattern for rAAA, a "two-stop" referral pattern results in a lower population-based survival rate for patients 65-74 years old, but the consequences would be small even if a "one-stop" referral pattern could be generally accomplished.

Place, publisher, year, edition, pages
Turin, Italy: Edizioni Minerva Medica , 2013. Vol. 32, no 5, 492-500 p.
Keyword [en]
Abdominal aortic aneurysm ruptured one-stop two-stop
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-102480PubMedID: 23903308OAI: oai:DiVA.org:liu-102480DiVA: diva2:678438
Available from: 2013-12-12 Created: 2013-12-12 Last updated: 2017-12-06
In thesis
1. Abdominal Aortic Aneurysm: Aspects on how to affect mortality from rupture
Open this publication in new window or tab >>Abdominal Aortic Aneurysm: Aspects on how to affect mortality from rupture
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Abdominal Aortic Aneurysm (AAA) is a disease that mainly affects elderly men, and ruptured AAA (rAAA) is associated with a mortality of > 80%. AAA seldom gives any symptoms prior to rupture.

The aims of this thesis were to investigate different aspects of how to affect mortality from rAAA.

In Study I, we identified 849 patients treated for rAAA during 1987-2004, and studied the 30-day survival after surgery, depending on whether they came directly to the treating hospital (one-stop) or were transferred via another hospital (two-stop). A two-stop referral pattern resulted in a 27% lower population-based survival rate for patients 65-74 years of age. However, the consequences would be small even if a one-stop referral pattern could be generally accomplished, due to the huge over-all mortality related to rAAA, hence an argument to find and treat AAA before rupture, e.g. by screening.

In Study II, we examined the AAA-prevalence and the risk factors for AAA among 70-year-old men. The screening-detected AAA-prevalence was 2.3%, thus less than half the predicted. The most important risk factor was smoking.

In Study III, we compared the screening-detected AAA-prevalence, the attendance rate, and the rate of opportunistic detection of AAA, between almost 8000 65- and 6000 70-year-old men. There was no difference in the screening-detected prevalence; probably due to the fact that almost 40% of the AAAs among the 70-year-old were already known prior to screening, compared to roughly 25% in the 65-year-old. The attendance rate was higher among the 65-year-old men, 85.7% compared 84.0% in the 70-year-old. Thus, there is no benefit of screening for AAA among 70- instead of 65-year-old men.

In Study IV, a cost-effectiveness analysis, we found that screening for AAA still appears to be cost-effective, despite profound changes in disease pattern and AAA-management.

In conclusion, we found that mortality from rAAA is not affected in any substantial way by different referral patterns and hence centralisation of services for AAA/rAAA is not a solution. A better alternative is to prevent rupture through early detection by screening. Screening 65-year-old men for AAA still appears to be cost-effective, despite profound changes in disease pattern and AAA-management during the last decade. Screening 70- instead of 65-year-old men will not increase the efficacy of screening.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. 113 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1381
Keyword
abdominal aortic aneurysm rupture AAA rAAA screening one-stop two stop prevalence risk factor cost-effectiveness
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-102482 (URN)10.3384/diss.diva-102482 (DOI)978-91-7519-503-2 (ISBN)
Public defence
2014-01-31, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Heart Lung FoundationCounty Council of Östergötland
Available from: 2014-01-08 Created: 2013-12-12 Last updated: 2017-03-27Bibliographically approved

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Hager, JakobLundgren, Fredrik

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