Highlights
- •Retrospective cohort study of prospectively collected linked administrative data.
- •There was a significant increase in mortality at home, mortality prior to operation, and overall 30-day mortality for patients with ruptured abdominal aortic aneurysm (RAAA) with travel time ≥1 hr (n = 317) to vascular care compared to <1 hr (n = 250).
- •In patients who received an operation (n = 294), there was no association between increased travel time and mortality.
Background
Centralization of vascular surgery care for Ruptured Abdominal Aortic Aneurysms (RAAAs)
to high-volume tertiary centers may hinder access to timely surgical intervention
for patients in remote areas. The objective of this study was to determine the association
between distance from vascular care and mortality from RAAAs in the province of Nova
Scotia, Canada.
Methods
A retrospective cohort study of all RAAAs in Nova Scotia between 2005 and 2015 was
performed through linkage of administrative databases. Patients were divided into
groups by estimated travel time from their place of residence to the tertiary center
(<1 hr and ≥1 hr) using geographic information software. Baseline and operative characteristics
were identified for all patients through available databases and completed through
chart review. Mortality at home, during transfer to the vascular center, and overall
30-day mortality were compared between groups using t-test and chi-squared test, as appropriate. Multivariable logistic regression analysis
was used to calculate the independent effect of travel time on survival outcomes.
Results
A total of 567 patients with RAAA were identified from 2005–2015, of which 250 (44%)
resided <1 hr travel time to the tertiary center and 317 (56%) resided ≥1 hr. On multivariable
analysis, travel time ≥1 hr from vascular care was an independent predictor of mortality
at home (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.07–2.63, P = 0.02), mortality prior to operation (OR 2.64, 95% CI 1.81–3.83, P < 0.001), and overall 30-day mortality (OR 1.61, 95% CI 1.10–2.37, P = 0.02). In patients who received an operation (n = 294), there was no association between increased travel time and mortality (OR
1.02, 95% CI 0.60–1.73, P = 0.94).
Conclusions
Travel time ≥1 hr to the tertiary center is associated with significantly higher mortality
from ruptured abdominal aortic aneurysm (AAA). However, there was no difference in
overall chance of survival between groups for patients that underwent AAA repair.
Therefore, strategies to facilitate early detection, and timely transfer to a vascular
surgery center may improve outcomes for patients with RAAA.
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Article info
Publication history
Published online: December 05, 2022
Accepted:
November 5,
2022
Received:
June 22,
2022
Footnotes
Health Data Nova Scotia Disclaimer: The data used in this report were made available by HDNS of Dalhousie University. The observations and opinions expressed are those of the authors and do not represent those of either HDNS or the Department of Health and Wellness.
Declarations of interest: None.
Funding sources: This study was funded by the Dalhousie University Department of Surgery SEED Grant (Award #1021948). The funding source did not have any role or input in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Author contributions: Samuel Jessula, Claudia Cote, Patrick Casey, Matthew Smith and Christine Herman designed the study. Claudia Cote and Christine Herman obtained the data and appropriate linkage across databases. Samuel Jessula, Claudia Cote, Gavin Tansley and Christine Herman analyzed the data. Samuel Jessula, Claudia Cote, Matthew Cooper, Garrett McDougall, Matthew Kivell, Young Kim, Patrick Casey, Matthew Smith and Christine Herman drafted and edited the manuscript.
Presentation Information: This study was presented as a podium presentation at the 2021 Canadian Society for Vascular Surgery (CSVS) Annual Meeting as well as in the Poster section at the 2021 Eastern Vascular Society (EVS) Annual Meeting in Charleston, SC.
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