Regional disparities in incidence, handling and outcomes of patients with symptomatic and ruptured abdominal aortic aneurysms in Norway

Abstract

Objectives: To study incidence, handling and outcome of patients hospitalised with symptomatic and ruptured abdominal aortic aneurysm in Norway.

Design, material and methods: Retrospective study of 1291 patients, between January 2008 and August 2010 using the National Patient Registry and a regional vascular surgery registry. We applied a stepwise logistic regression model to detect differences in regional in-hospital mortality.

Results: 385/711 (54%) patients hospitalised for aneurysm rupture, rAAA (ICD-10: I71.3), died. The odds of dying varied with a factor 2.3 between the extreme regions. 475/711 (67%) underwent repair, 323 survived, giving an in-hospital mortality rate of 32% after surgery. Older patients were significantly less likely to be transported for surgery. The overall incidence for patients aged >50 was 16.6 rAAA per 100,000 person-years. There was remarkable variation across counties with rates between 7.7 and 26.8. A total of 580 patients were hospitalised with suspected symptomatic aneurysms (ICD-10:I71.4, acute admission); 224 (39%) were treated with aneurysm repair, 356 (61%) were discharged without repair without a significant difference across health regions.

Conclusions: For rAAA, we found substantial geographical variations in incidence, surgery and patient outcome. These results highlight the need for increased awareness about the condition and suggest ways to improve care trajectories to reduce delay to surgery, thereby minimising rupture mortality.