Original title: Mortality from ruptured abdominal aortic aneurysms: clinical lessons from a comparison of outcomes in England and the USA. Reference: Karthikesalingam A et al. Lancet. 2014;383:963-969.
Treatment strategy for rAAA patients may vary according to the different centers. This study analyzed in-hospital mortality, and mortality after intervention of all patients admitted with rAAA between 2005 and 2010 in USA (n=23838) and compared outcomes with a similar population in England (n=11799).
Global in-hospital mortality was lower in the USA than in England (53.05% vs. 65.9%; p<0.0001); however, looking into patients that received some kind of intervention, mortality was similar (41.7% vs 41.6%).
Interventions (conventional surgical or endovascular repair) were more frequent in USA than in England (80.4% vs 58.4%; p<0.001), as frequent were specifically endovascular interventions (20.8% vs 8.5%, p<0.0001). These differences persisted after aged matched and sex matched comparisons.
In both countries, mortality decreased with endovascular treatment. Center experience in endovascular repair and weekday admission were also predictors of lower mortality.
Conclusion
In-hospital survival and intervention rates (especially endovascular) are lower in England than in USA for patients admitted with rAAA. Patients that received endovascular treatment saw lower mortality rates.
Editorial Comment
The absence of follow up beyond hospital discharge is a limitation to this study, as it is the lack of data on anatomical characteristics or clinical status in deciding between conventional surgical strategy vs. endovascular repair with prosthesis.
As in most cases, prevention with a relatively simple screening to allow programmed treatment would greatly reduce mortality for AAA and save the efforts it requires once ruptured. In the event of rupture, the best strategy to reduce mortality seems to be endovascular treatment in an experienced center.
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