Qureshi N A, Rehman A, Slater N, Moss E, Shiralkar S, Patel R T, Grimley R P, Jayatunga A P
Department of General and Vascular Surgery, Russells Hall Hospital, Dudley, West Midlands, UK.
Ann Vasc Surg. 2007 Nov;21(6):749-53. doi: 10.1016/j.avsg.2007.03.022. Epub 2007 May 18.
The incidence of patients presenting with both ruptured abdominal aortic aneurysm (RAAA) and elective abdominal aortic aneurysm (EAAA) increases with age. The aim of our study was to find out the incidence of RAAA, age and sex groups of patients at risk, and 30-day all-cause perioperative mortality associated with RAAA as well as EAAA repair in a busy district general hospital over a 15-year time period. All patients operated for AAA during 1989-2003, both elective and ruptured, were included in the study. Patients who died in the community from RAAA were also included. The data were collected from the hospital information system, theater logbooks, intensive therapy unit records, postmortem register, and patients' medical notes. We divided the data for RAAA into two groups of 7.5 years each to see if there was any improvement over time in 30-day postoperative mortality. There were 816 cases of AAA, which included 468 RAAAs (57%) and 348 EAAAs (43%). Out of 468 RAAAs, 243 patients had emergency repair, of whom 213 were males. There were 201 patients who had RAAA postmortem (43%). Median age (range) was 73 (54-94) years in males and 77 (52-99) years in females, with a male-to-female ratio of 7:1. The peak incidence of RAAA was over 60 years of age in males and 70 years in females. Incidence of RAAA was 7.3/100,000/year in males and 5/100,000/year in females. For RAAA, 30-day perioperative mortality was 43% (105/243) while overall mortality was 70% (330/468), which includes deaths in the community. There was no improvement in 30-day mortality over time after comparing data for the first 7.5 years (50/115, 43.5%) with those for the second set of 7.5 years (55/128, 43%). There were 348 patients who had EAAA repair over the same period, comprising 282 males, with a male:female ratio of 4.3:1. The 30-day mortality in the elective group was 7.75%. Incidence and mortality of RAAA remain high. A high proportion of patients with AAA remain undiagnosed and die in the community. More lives may be saved if a screening program is started for AAA.
同时患有破裂性腹主动脉瘤（RAAA）和择期腹主动脉瘤（EAAA）的患者发病率随年龄增长而增加。我们研究的目的是找出RAAA的发病率、高危患者的年龄和性别组，以及在一家繁忙的地区综合医院15年期间与RAAA以及EAAA修复相关的30天全因围手术期死亡率。1989年至2003年期间所有接受AAA手术的患者，包括择期和破裂性患者，均纳入研究。因RAAA在社区死亡的患者也包括在内。数据收集自医院信息系统、手术日志、重症监护病房记录、尸检登记册和患者病历。我们将RAAA的数据分为两组，每组7.5年，以查看30天术后死亡率是否随时间有所改善。共有816例AAA病例，其中包括468例RAAA（57%）和348例EAAA（43%）。在468例RAAA中，243例患者接受了急诊修复，其中213例为男性。有201例患者进行了RAAA尸检（43%）。男性的中位年龄（范围）为73（54 - 94）岁，女性为77（52 - 99）岁，男女比例为7:1。RAAA的发病高峰在男性为60岁以上，女性为70岁。男性RAAA的发病率为7.3/10万/年，女性为5/10万/年。对于RAAA，30天围手术期死亡率为43%（105/243），而总体死亡率为70%（330/468），这包括在社区的死亡病例。在比较前7.5年（50/115，43.5%）和后7.5年（55/128，43%）的数据后，30天死亡率没有随时间改善。同期有348例患者接受了EAAA修复，其中包括282例男性，男女比例为4.3:1。择期组的30天死亡率为7.75%。RAAA的发病率和死亡率仍然很高。很大一部分AAA患者仍未被诊断并在社区死亡。如果启动AAA筛查计划，可能会挽救更多生命。
