Ruptured abdominal aortic aneurysm mortality greater in England vs. USA.

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1. Ruptured abdominal aortic aneurysms (rAAA) have a significantly higher in-hospital mortality rate in England compared to the USA.

2. The best outcomes in both countries were obtained in teaching hospitals with the highest bed capacity and greatest annual caseload of rAAA.

Evidence Rating Level: 2 (Good)

Study Rundown: Ruptured abdominal aortic aneurysms (rAAA) are frequently fatal and have high mortality rates even with surgical intervention. This study compared the outcomes of patients with rAAA in England and the USA from 2005 to 2010 and found that the overall in-hospital mortality was significantly lower in the USA. The study also found that American hospitals offered surgical treatment more often than non-corrective treatment for rAAA and performed endovascular repairs more than twice as often as England. The best outcomes in both England and the USA were observed with an increased use of rEVAR, in hospitals with a higher volume of rAAA cases, teaching status and a large bed capacity, and admission on a weekday. This study was limited in that it did not follow patient mortality rates after discharge and endovascular outcomes could not be adjusted for aortic morphology or hemodynamic status. The results highlight that the treatment and management of rAAA cases in the USA varied considerably from England and the findings can be used to help improve international standards in the treatment of rAAA.

Click to read the study in The Lancet

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Relevant Reading: A meta‐analysis of 50 years of ruptured abdominal aortic aneurysm repair

In-Depth [retrospective review]: This study analyzed the outcomes of 11,799 patients from England and 23,838 patients from the USA with a ruptured abdominal aortic aneurysm (rAAA) during 2005 to 2010, using data from the Hospital Episode Statistics for England and the Nationwide Inpatient Sample for USA. The study compared the in-hospital mortality, rate of non-intervention vs. corrective intervention (open surgery or endovascular repair [rEVAR]), and the proportion of patients offered rEVAR. The study also assessed hospital-level factors, such as teaching vs non-teaching hospital status, hospital bed capacity, and admission on a weekday vs. a weekend.

Outcomes in the USA compared to England showed a lower in-hospital mortality rate (53.05% vs 65.90%; p<0.0001), a greater number of patients offered corrective treatment (19174 [80.43%] vs 6897 [58.45%]; p<0.0001), and a greater proportion of rEVAR (4003 [20.88%] vs 589 [8.54%]; p<0.0001). Predictors of mortality in England included treatment at a non-teaching hospital ([Odds ratio, OR] 1.462, p<0·0001), admission on a weekend vs a weekday (OR 1.144, p=0.0072), and treatment following transfer to different hospital (OR 0.646, p<0.0001). Predictors of mortality in the USA included treatment at a non-teaching hospital (OR 1.272, p=0.0238) and treatment on a weekend vs a weekday (OR 1.156, p=0.0432).

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