[The Impact of Patient Transfer After Rupture of an Abdominal Aortic Aneurysm].

Abstract

Objective: determine whether patient transfer adversely affects the survival of ruptured abdominal aortic aneurysm (rAAA) patients after conventional surgery.

Methods: We performed a retrospective review of all patients undergoing attempted repair of an rAAA at a tertiary center, over January 2008 and December 2014. Patients were divided into those presenting directly to our center and those transferred from another hospital. The main outcome variable was 24-hour or 30-day mortality, with secondary variables including time to surgical treatment, length of intensive care unit stay and total length hospitalization.

Results: 78 patients (88% men) underwent attempted open repair of an rAAA during this period, 69% (54 cases) were transferred from another institution. Both groups were similar in terms of demographic characteristics, comorbidities and hemodynamic stability. The overall mortality rate was 51% at 30 days. Transferred patients took twice as long as direct patients to get to the operating room (median 7,9 vs. 3,9 horas, p < 0,05), Although the difference for surgery treatment, there was no difference in 24-hour and 30-day mortality between the transferred group and direct group (26% e 50% vs. 29% e 58%, p < 0,05). Mean intensive care unit stay (median, 12 vs. 4 dias, p = 0,04) and total hospitalization (median 11 vs. 4 dias, p = 0,04) were sustantially superior in the transferred group.

Conclusions: Transfer of patients with RAAA in this series results in a doubling of the time interval between initial patient presentation and arrival in the operating room. This, however, did not result in any disadvantage in the survival rate between the groups. The total length and resources consumption were higher in the transfer group. These results may be attributed to a pre-selection of patients (clinically stable) who are able to tolerate such a delay in surgical treatment, secondary to transfer.