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Ruptured abdominal aortic aneurysm mortality rates higher in England
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In-hospital mortality due to ruptured abdominal aortic aneurysm is significantly lower in the United States than in England, according to recent findings.
Additionally, US hospitals had a threefold greater uptake of endovascular interventions for ruptured abdominal aortic aneurysm than hospitals in England, suggesting that this modality is underutilized in England.
The researchers utilized demographic and in-hospital outcome data for patients diagnosed with ruptured abdominal aortic aneurysm between 2005 and 2010. The information was gleaned from two sources: Hospital Episode Statistics for England, an administrative dataset for the National Health Service; and the National Inpatient Sample, an anonymized, stratified sample of 20% of all discharges from US hospitals.
The study population consisted of 11,799 patients in England and 23,838 in the United States. The primary outcome measures were in-hospital mortality, post-intervention mortality and the decision to pursue noncorrective treatment, defined as a diagnostic code for ruptured abdominal aortic aneurysm without a procedural code for open surgical or endovascular intervention. Secondary outcome measures included the percentage of operated cases treated with an endovascular procedure, length of hospital stay, discharge destination and the percentage of patients treated at teaching hospitals or hospitals with varying bed capacity.
US hospitals had lower in-hospital mortality than hospitals in England (53% vs 66%; P<.0001). Additionally, US hospitals offered intervention, whether open or endovascular, to a greater percentage of patients than the hospitals in England (80% vs. 58%; P<.0001). Endovascular repair was more frequently utilized in the United States than in England (21% of cases vs. 9%; P<.0001). Rates of mortality after intervention were comparable between the two countries (41.77% for England vs. 41.65% for the US).
Age- and gender-matched analyses indicated significantly elevated overall in-hospital mortality (OR=1.473; 95% CI, 1.376-1.576) and noncorrective treatment (OR=3.193; 95% CI, 2.951-3.455) in England compared with the United States. Weekend admission and treatment in a nonteaching institution were associated with increased mortality risk in both countries. Interhospital transfer decreased the likelihood of undergoing noncorrective treatment in both England (OR=0.431, 95% CI; 0.367-0.507) and the United States (OR=0.637; 95% CI, 0.431-0.943), whereas weekend admission (OR=1.274; 95% CI, 1.154-1.407) and admission to a nonteaching institution (OR=1.459; 95% CI, 1.301-1.636) increased the risk in England.
“As far as we are aware, this study is the first international comparative report of unselected patients with [ruptured abdominal aortic aneurysm] in England and the USA with use of nationally representative data,” the researchers wrote. “Outcomes in England might be improved by reductions in rates of noncorrective treatment and increases in provision of endovascular technology for [ruptured abdominal aortic aneurysm]. Service configuration should direct [ruptured abdominal aortic aneurysm] patients to teaching hospitals with a high aortic workload, endovascular capabilities and proficiency in weekend working.”
Disclosure: See the full study for a list of relevant financial disclosures.
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