Advantage of a one-stop referral and management service for ruptured abdominal aortic aneurysms

Background: In 2005, 4003 deaths in England and Wales were attributed to ruptured abdominal aortic aneurysm (RAAA). This study examined the referral and management patterns of this condition within one English county. Methods: West Sussex has a population of 811 000 and is served by five hospitals with two main vascular networks. Between January 2005 and December 2007, data for community and in‐hospital RAAA interventions and deaths were obtained. Probability of intervention and outcome for each network were calculated. Results: Of 341 RAAA, 228 (66·9 per cent) presented to hospital. The mean distance travelled to hospitals with a full on‐site vascular service was 17·6 (95 per cent confidence interval 15·5 to 19·7) km (124 patients) compared with 11·0 (9·5 to 12·7) km (104 patients) to hospitals with a partial or no vascular service (P < 0·001). Patients managed by the network with a one‐stop RAAA management policy had an odds ratio of 2·4 for undergoing surgery and 2·5 for surviving the operation (P = 0·001 and P = 0·017 respectively). Conclusion: Patients with RAAA should be offered a one‐stop emergency vascular service even if this involves further travel. Such a strategy offers significantly higher chance of intervention and survival from ruptured AAA. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Initial review at non‐vascular centre can be avoided