Ruptured abdominal aortic aneurysm: a community experience.

A retrospective review of a community experience with ruptured abdominal aortic aneurysm (AAA) identified 117 cases from five community hospitals over a 12-year period. There were 90 men (77%) and 27 women (23%), ranging in age from 49 to 87 years. In the initial 6 years, the majority of operations were performed by general surgeons, with a survival rate of 35%. In the latter 6 years, most operations were performed by vascular surgeons, with a survival rate of 61%. For the entire period, patient survival with vascular surgeons was significantly greater than that with general surgeons (P < 0.05). Preoperative risk factors assessed in terms of their impact on survival were similar to those of previously reported series. Patients in the latter half of the study were older (72.8 versus 69.9 years), with survivors requiring a longer length of hospital stay than those in the initial 6-year period (34.5 versus 22.5 days), indicative of the changing patient population and having diagnostic-related group implications. There was also increased reliance by emergency room physicians on computed tomography for diagnosis, with increased survival rates. Misdiagnosis (patient sent home or admitted with incorrect diagnosis) occurred in 12 patients with no deleterious impact on survival. Some 15 patients with known AAA who either refused surgery for medical reasons or were considered to be at excessive risk for elective resection had a survival rate of 33%, indicating a definite potential for survival. It is concluded that there is continuing evolution of care for patients with ruptured AAA in the community setting.(ABSTRACT TRUNCATED AT 250 WORDS)