Abstract
ObjectiveTo assess whether survival and clinical events following elective abdominal aortic aneurysm (AAA) repair were associated with remoteness of residence in North Queensland, Australia.MethodsThis retrospective cohort study included participants undergoing elective AAA repair between February 2002 and April 2020 at two hospitals in Townsville, North Queensland, Australia. Outcomes were all-cause survival and AAA-related events, defined as requirement for repeat AAA repair or AAA-related mortality. Remoteness of participant’s place of residence was assessed by the Modified Monash Model classifications and estimated distance from the participants’ home to the tertiary vascular centre. Cox proportional hazard analysis examined the association of remoteness with outcome.ResultsThe study included 526 participants undergoing elective repair by open (n = 204) or endovascular (n = 322) surgery. Fifty-four (10.2%) participants had a place of residence at a remote or very remote location. Participants' were followed for a median of 5.2 (inter-quartile range 2.5–8.3) years, during which time there were 252 (47.9%) deaths. Survival was not associated with either measure of remoteness. Fifty (9.5%) participants had at least one AAA-related event, including 30 (5.7%) that underwent at least one repeat AAA surgery and 23 (4.4%) that had AAA-related mortality. AAA-related events were more common in participants resident in the most remote areas (adjusted hazard ratio 2.83, 95% confidence intervals 1.40, 5.70) but not associated with distance from the participants’ residence to the tertiary vascular centreConclusionsThe current study found that participants living in more remote locations were more likely to have AAA-related events but had no increased mortality following AAA surgery. The findings emphasize the need for careful follow-up after AAA surgery. Further studies are needed to examine the generalisability of the findings.
Highlights
Abdominal aortic aneurysm (AAA) is a common cause of death in older adults due to aortic rupture [1]
Fifty-four (10.2%) participants had a place of residence at a remote or very remote location
AAA-related events were more common in participants resident in the most remote areas but not associated with distance from the participants’ residence to the tertiary vascular centre
Summary
Abdominal aortic aneurysm (AAA) is a common cause of death in older adults due to aortic rupture [1]. A number of prior observational studies have reported that the outcome of AAA repair is worse in hospitals with low volumes and this has led to the centralization of services for AAA repair in some countries, such as the UK and Spain [4,5,6]. The European Society for Vascular Surgery guidelines recommend that AAA repair should only be considered in centers with a minimum annual case volume of 30 [7]. Centralizing vascular surgery practice has some challenges for consumers and providers, in countries where populations are dispersed over large land areas. Individuals requiring AAA repair need to attend one of these hospitals, which may require them to travel as far as 900 km. Living in more remote and distant localities can be associated with challenges in obtaining medical care and attending tertiary hospitals, which is thought to contribute to geographic disparity in the outcomes for many chronic diseases [10, 11]
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