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Inter-hospital transfer of patients with ruptured abdominal aortic aneurysm in Switzerland

Open AccessPublished:December 16, 2022DOI:https://doi.org/10.1016/j.ejvs.2022.12.009
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      Abstract

      Objectives

      To analyse the association of inter-hospital transfer on hospital mortality in patients with ruptured abdominal aortic aneurysms (rAAA) in Switzerland.

      Design

      Secondary data analysis of case-related hospital discharge data from the Swiss Federal Statistical Office for the years 2009-2018. All cases with rAAA as primary or secondary diagnosis were included. Cases with rAAA as a secondary diagnosis without surgical treatment and cases that had been transferred to another hospital without surgical treatment at the referring hospital were excluded.

      Methods

      Logistic regression models for hospital mortality were constructed with age, sex, type of admission, van Walraven comorbidity score, type of treatment, insurance class, hospital level, and year of treatment as independent variables.

      Results

      From 1 January 2009 to 31 December 2018, 1798 cases with rAAA were treated either surgically (62.5%) or palliatively (37.5%) in Switzerland. 72.9% of the cases were directly treated (surgically or palliative) at the hospital of first presentation, whereas 27.1% of all cases with rAAA were transferred between hospitals. The overall crude hospital mortality was 50.3%; in the surgically treated cohort it was 23.1%, in the palliative treated cohort it was 95.7%.Inter-hospital transfer was associated with better survival compared to patients directly admitted (OR 0.52, 95%-CI: 0.36-0.75, p<.001). Treatment in major hospitals was associated with a significantly higher mortality compared to treatment in university hospitals (OR 1.98, 1.41-2.79, p<.001). There was no evidence for an association of open repair with hospital mortality, OR 1.06, 0.77-1.48, p=.722, compared to endovascular repair.

      Conclusions

      In a healthcare system such as Switzerland with a highly specialised rescue chain, transfer of haemodynamically stable patients with rAAA is probably safe. In this setting, a centralised medical care might outweigh the potential disadvantages of a limited delay due to patient transfer. Further studies are needed to address potential confounding factors such as hemodynamic and anatomical features.

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