ArticlesMortality from ruptured abdominal aortic aneurysms: clinical lessons from a comparison of outcomes in England and the USA
Introduction
The rupture of an abdominal aortic aneurysm (rAAA) is frequently fatal and accounts for the death of at least 45 individuals per 100 000 population.1 Surgical intervention is associated with high mortality, and the evidence to suggest improvement in outcome with time is inconsistent.2, 3, 4, 5 In both the USA and England, evidence suggests interhospital variation in the mortality of patients admitted to hospital with rAAA. The outcome of patients with rAAA also varies between countries, with different outcomes published for health-care systems in the USA, the UK, western Europe, and Australia.6, 7, 8
Modifiable technical, organisational, or hospital-related factors play an important part in patient care, and merit further study to optimise service delivery and improve patient outcomes. A detailed study to compare international outcomes for rAAA would place data from an individual health-care system in a broad context, and might allow the identification of factors that affect survival or the formulation of pathways to improve care.
We present the outcomes of patients with rAAA in England and the USA, with comparison of in-hospital mortality, the proportion of patients managed by non-corrective treatment, and the availability of endovascular surgery.
Section snippets
Study design
Demographic and in-hospital outcome data were extracted from Hospital Episode Statistics (HES) and the Nationwide Inpatient Sample (NIS) for all patients diagnosed with rAAA between Jan 1, 2005, and Dec 31, 2010. The HES are the administrative dataset for the English National Health Service (NHS) and contain information about every admission of a patient to hospital. The NIS from the Healthcare Cost and Utilisation Project, Agency for Healthcare Research and Quality, is an anonymised,
Results
11 799 patients in England and 23 838 patients in the USA were admitted to hospital with a rAAA during the study period. In England, the mean age was 78·2 years (SD 8·0) and 8694 patients (73·7%) were men. In the USA, the mean age was 76·6 years (SD 9·6) and 17 020 (71·4%) of patients were men. The appendix shows the full demographic details of patient characteristics.
In-hospital mortality was lower in the USA than in England (table 1). Intervention (rEVAR or open surgery) was offered to a
Discussion
The main finding of this study was that the in-hospital mortality of patients with rAAA was significantly lower in the USA than in England. This difference was mainly because US hospitals were less likely to manage rAAA by non-corrective treatment and offered aneurysm repair to a significantly greater proportion of patients. Although operative mortality was similar between countries, patients in the USA were more than twice as likely to be offered rEVAR and were more often managed in a teaching
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