Background:

Operative repair of ruptured abdominal aortic aneurysm (RAAA) is associated with a high mortality rate but reported figures vary widely. The aim of this study was to estimate the operative mortality of RAAA repair and determine how it has changed over time.



Methods:

A meta-analysis of all English language literature quoting figures for operative mortality of RAAA repair.



Results:

The pooled estimate for the overall operative mortality rate of RAAA repair from 1955 to 1998 was 48 (95 per cent confidence interval 46 to 50) per cent. Meta-regression analysis of operative mortality over time demonstrated a constant reduction of approximately 3·5 per cent per decade (1954–1997) with an operative mortality rate estimate for the year 2000 of 41 per cent. Seventy-seven studies reported intraoperative mortality but, while this appears to have remained constant over time, there was evidence of the presence of publication bias in the subgroup of papers reporting this outcome. There was no evidence of publication bias for the overall operative mortality outcome.



Conclusion:

Contrary to the conclusion of recent studies, this paper demonstrates a gradual reduction with time in the operative mortality rate of RAAA repair. © 2002 British Journal of Surgery Society Ltd

A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair

Ruptured abdominal aortic aneurysm: the Harborview experience.

In an audit of 1190 emergency admissions with abdominal pain (1166 patients) in a general surgical unit, the diagnosis was non-specific abdominal pain (NSAP) in 415 (35 per cent), acute appendicitis in 200 (17 per cent) and intestinal obstruction in 176 (15 per cent). The largest number of admissions occurred in the age groups 10-29 years (31 per cent) and 60-79 years (29 per cent). Surgical operations were performed in 551 patients (47 per cent) and there was a 16 per cent incidence of unnecessary appendicectomy (22 per cent in the age group 20-29 years). Fifty-one deaths resulted in a 30-day hospital mortality rate of 4.4 per cent and a perioperative mortality rate of 8 per cent. The mortality rate increased significantly in patients aged greater than or equal to 60 years, and patients aged 80-89 years had a perioperative mortality rate of 20 per cent. The causes of perioperative death included laparotomy for inoperable disease (28 per cent), ruptured abdominal aortic aneurysm (23 per cent), perforated peptic ulcer (16 per cent) and colonic resections (14 per cent). The perioperative mortality rates for ruptured aneurysm and perforated ulcer were 71 and 23 per cent respectively. The duration of inpatient stay increased significantly with the age of the patients, including those with NSAP. The results of the study indicate a need to review the methods of management of ruptured aortic aneurysm and perforated peptic ulcer, the methods of diagnosis of appendicitis, particularly in young females, and the factors that determine the duration of stay of patients suffering from NSAP.

Abdominal pain: a surgical audit of 1190 emergency admissions

Rupture in small abdominal aortic aneurysms.

Between 1974 and 1984, 174 patients with ruptured abdominal aneurysms have been treated by three vascular surgeons. The 11-year period showed a dramatic increase in the number of patients presenting with ruptured aneurysms. The overall operative survival, including patients who died before a graft could be inserted, was 67 per cent with improvement from 60 per cent in the first half of the period to 69 per cent in the second. The overall survival rate for the 162 who had a completed graft was 72 per cent. Reference to data from the Lothian area surgical audit showed that there has been a transfer of responsibility from general to vascular surgeons with an increase in the proportion of patients treated by operation. Concentration of care within a single specialized unit appears to have had a favourable effect on survival.

Badami Jp

Papers

Improved results of operation for ruptured abdominal aortic aneurysms.