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 811000 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.