Vetrhus Morten, Reite Andreas, Vennesland Jørgen B, Søreide Kjetil
Department of Surgery, Vascular Surgery Unit, Stavanger University Hospital, PO Box 8100, 4068, Stavanger, Norway.
Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
World J Surg. 2018 Jul;42(7):2269-2276. doi: 10.1007/s00268-017-4445-1.
The available literature on ruptured abdominal aortic aneurysms (rAAA) centers on survival after operation and commonly, reasons why some patients do not undergo surgery are not addressed. The aim of the present study is to examine, in a population-based cohort, the characteristics, stratification and time to death of patients admitted to hospital, but not undergoing operation for rAAA.
A retrospective, single-center study. All patients admitted to Stavanger University Hospital from the primary catchment area with rAAA on admission or in-hospital from 2000 to 2014 were included.
Altogether 214 patients with rAAA were identified; 57 (27%) patients did not undergo surgery. The proportion of women was significantly higher (37 vs. 14%; p < .001) in patients not having surgery. The reasons for not undergoing operation were patient 'not fit for surgery' (30%), 'dying or agonal' at time of diagnosis (26%), 'did not want operation' (21%) and 'diagnosed at autopsy' (23%). Of the non-operated patients, 45 had rAAA on arrival to hospital, 12 had in-hospital rupture and 21 patients had previously been diagnosed with an abdominal aortic aneurysm. Non-operative treatment was uniformly fatal. The 45 patients with rAAA on arrival were scored using four scoring systems, the predicted mortality varied widely, and the median time from admission to death was 7.4 h (range 0-1337).
In about half of patients, a decision not to operate was made by the consultant vascular surgeon or the patient. In the subgroup of patients not diagnosed until autopsy or having an in-hospital rupture, an earlier diagnosis might have altered the outcome.
关于破裂腹主动脉瘤（rAAA）的现有文献主要集中在手术后的生存率，通常未涉及一些患者未接受手术的原因。本研究的目的是在一个基于人群的队列中，研究因rAAA入院但未接受手术的患者的特征、分层及死亡时间。
一项回顾性单中心研究。纳入2000年至2014年期间从主要集水区入院时或住院期间患有rAAA的所有患者，这些患者均入住斯塔万格大学医院。
共识别出214例rAAA患者；57例（27%）患者未接受手术。未接受手术的患者中女性比例显著更高（37%对14%；p<0.001）。未接受手术的原因包括患者“不适合手术”（30%）、诊断时“濒死或临终”（26%）、“不想手术”（21%）以及“尸检时确诊”（23%）。在未接受手术的患者中，45例入院时即患有rAAA，12例在住院期间破裂，21例患者此前已被诊断患有腹主动脉瘤。非手术治疗均导致死亡。对45例入院时即患有rAAA的患者使用四种评分系统进行评分，预测死亡率差异很大，从入院到死亡的中位时间为7.4小时（范围0 - 1337小时）。
在约一半的患者中，不进行手术的决定由血管外科顾问医生或患者做出。在尸检时才确诊或在住院期间破裂的患者亚组中，更早的诊断可能会改变结局。
