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Regionalization of Emergent Vascular Surgery for Patients with Ruptured AAA Improves Outcomes
Courtney J Warner*1, Sean P. Roddy*1, Benjamin B. Chang*1, Paul B. Kreienberg*1, Yaron Sternbach*1, John B. Taggert*1, Kathleen J. Ozsvath*1, Chin-Chin Yeh*1, Steven C. Stain2, R. Clement Darling1
1The Vascular Group, Albany, NY;2Albany Medical Center, Albany, NY

Objective: Safe and efficient EVAR for ruptured AAA (r-AAA) requires advanced infrastructure and surgical expertise not available at all US hospitals. The objective was to assess the impact of regionalizing r-AAA care to centers equipped for both open surgical repair (r-OSR) and EVAR (r-EVAR) by vascular surgeons.
Methods: A retrospective review of all patients with r-AAA undergoing open or endovascular repair in a 12-hospital region. Patient demographics, transfer status, type of repair, and intraoperative variables were recorded. Outcomes included perioperative morbidity and mortality.
Results: 451 patients with r-AAA were treated from 2002-2015. 321 (71%) presented initially to community hospitals (CH) and 130 (29%) presented to the tertiary medical center (MC). Of the 321 patients presenting to CH, 133 (41%) were treated locally (131 OSR; 2 EVAR) and 188 (59%) were transferred to the MC. In total 318 patients were treated at the MC (122 OSR; 196 EVAR). At the MC, r-EVAR was associated with a lower mortality rate compared to r-OSR (20% vs. 38%, p=0.001). Transfer did not influence r-EVAR mortality (20% in r-EVAR presenting to MC vs. 20.1% in r-EVAR transferred, p>0.2). Overall r-AAA mortality at the MC was 20% lower than CH (26% vs. 46%, p<0.001).
Conclusions: Regionalization of r-AAA repair to centers equipped for both r-EVAR and r-OSR decreased mortality by 20%. Transfer did not impact the mortality of r-EVAR at the tertiary center. Care of r-AAA in the US should be centralized to centers equipped with available technology and vascular surgeons.


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