Abstract
Ruptured aortic aneurysm is a condition with a high rate of mortality that requires prompt surgical intervention. It has been noted that in some conditions requiring such prompt intervention, in-hospital mortality is increased in patients admitted on the weekends compared with patients admitted on weekdays. We sought to determine if this was indeed the case for both ruptured thoracic aortic aneurysms (TAA) and abdominal aortic aneurysms (AAA) and to elucidate the possible reasons. Using the Nationwide Inpatient Sample, a publicly available database of inpatient care, we analyzed the incidence of mortality among 7200 patients admitted on the weekends compared with weekdays for ruptured aortic aneurysm. Among these patients, 19% had a TAA and 81% had an AAA, and each group was analyzed for differences in mortality during the hospitalization. We adjusted for demographics, comorbid conditions, hospital characteristics, rates of surgical intervention, timing of surgical intervention, and use of additional therapeutic measures. Patients admitted on the weekend for both ruptured TAA and AAA had a statistically significant increase in mortality compared with those admitted on the weekdays (TAA: odds ratio, 2.55; 95% confidence interval, 1.77-3.68; P = .03; AAA: odds ratio, 1.32; 95% confidence interval, 1.13-1.55; P = .0004). Among those with TAA, a surgical intervention was performed on day of admission in 62.1% of weekday admissions vs 34.9% of weekend admissions (P < .0001). This difference was much smaller among those with an aortic aneurysm; 79.6% had a surgical intervention on day of admission on a weekday vs 77.2% on the weekend (P < .0001). Weekend admission for ruptured aortic aneurysm is associated with an increased mortality compared with admission on a weekday, and this is likely due to several factors including a delay in prompt surgical intervention.
Highlights
Patients with untreated large aortic aneurysms are more likely to die of aneurysm related complications, such as rupture or dissection, than anything else[1, 2]
Weekend admission for ruptured aortic aneurysm is associated with an increased mortality when compared to those admitted on the weekend and this is likely due to several factors including a delay in prompt surgical intervention
Patients treated surgically may undergo open surgical repair or endovascular aneurysm repair (EVAR), but in an emergent situation there are issues with aortic endografting, and up to 50% of patients do not have anatomy that is suitable for EVAR, and it is unclear at this time if EVAR has a clinical benefit[9, 10]
Summary
Patients with untreated large aortic aneurysms are more likely to die of aneurysm related complications, such as rupture or dissection, than anything else[1, 2]. In order to treat a patient with a ruptured aortic aneurysm, whether thoracic (TAA) or abdominal (AAA), surgical care is nearly universally necessary[8]. Institutions are frequently putting into place protocols for endovascular repair of ruptured aneurysms, given the emerging nature of this technology and the high level of specialization required to carry out the procedure, many hospitals are ill equipped to handle ruptured aneurysms in this manner[9]. Given the mortality associated with even treated ruptured aortic aneurysm, such critical surgical care should be available irrespective of when patients are admitted. It is alarming that in recent years, the quality of care of patients in hospitals depending on the day of admission has been increasingly called into question[11]
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