Landau John H, Novick Teresa V, Dubois Luc, Power Adam H, Harris Jeremy R, Derose Guy, Forbes Thomas L
Division of Vascular Surgery, London Health Sciences Centre & Western University, London, Ontario, Canada.
Vasc Endovascular Surg. 2013 May;47(4):288-93. doi: 10.1177/1538574413485648. Epub 2013 Apr 10.
Aneurysm repair is centralized in higher volume centers resulting in reduced mortality, with longer travel distances. The purpose of this study is to explore patients' preference between local care versus longer distances and lower mortality rates.
Patients with abdominal aortic aneurysm (AAA) measuring 4 to 5 cm and living at least a 1-hour drive from our hospital were asked to assume it had grown to 5.5 cm, and repair was recommended with a mortality risk of 2%. The level of additional risk they would accept to undergo surgery locally was determined.
A total of 67 patients were surveyed. If mortality risk was equivalent at the local and regional hospitals, 44% preferred care at our tertiary center, while 56% preferred surgery locally. If perioperative mortality was increased at the local hospital, 9% preferred local surgery.
The vast majority of patients with AAA will accept longer travel distances for care as long as it results in a reduction in perioperative mortality.
动脉瘤修复手术集中于手术量较大的中心可降低死亡率，但患者就诊距离会更远。本研究旨在探讨患者在本地治疗与更远距离及更低死亡率之间的偏好。
对腹主动脉瘤（AAA）直径为4至5厘米且居住在距离我院至少1小时车程处的患者，假设其动脉瘤已增大至5.5厘米，并建议进行修复手术，手术死亡率风险为2%。确定他们为在本地接受手术愿意额外承担的风险水平。
共调查了67例患者。如果本地和区域医院的死亡率风险相当，44%的患者倾向于在我们的三级中心接受治疗，而56%的患者倾向于在本地进行手术。如果本地医院围手术期死亡率增加，9%的患者倾向于在本地进行手术。
绝大多数腹主动脉瘤患者会接受更长的就诊距离，只要这能降低围手术期死亡率。
