Abstract
Objectives: The treatment outcome of ruptured abdominal aortic aneurysm (RAAA) remains poor. On the other hand, there is a serious doctor shortage in the provinces in Japan. The objective of this study was to analyze RAAA cases in Ibaraki Prefectural Central Hospital (IPCH), which is a local base provincial hospital, and to propose a strategy to improve the results of RAAA treatment. Methods: A retrospective analysis of 15 patients who underwent operation for RAAA at IPCH between July 2007 and September 2012 was undertaken. These patients were divided into two groups according to whether the referring physician had diagnosed RAAA (Group D) or not (Group N). Non-operative cases diagnosed as RAAA during the same period were also identified from the IPCH medical records. Results: Five patients (4 male and 1 female) aged 70.1±12.4 years in Group D and 10 patients (9 male and 1 female) aged 77.1±10.0 years in Group N were investigated. Group D had a significantly higher prevalence of hypotension (systolic blood pressure <100 mmHg) on arrival than did Group N. There was no significant difference in operative duration and blood loss between the two groups. In-hospital mortality was 0% and 30% for Group D and Group N, respectively. Hospital stay after operation tended to be longer in Group N than in Group D. Ten patients with a diagnosis of RAAA did not undergo surgery at IPCH; one female and one male patient were transferred to other hospitals and successfully treated surgically, and the other eight patients (4 male and 4 female) died in IPCH. Non-operative cases were significantly older and tended to be female compared with operative cases. Overall mortality including non-operative cases was 44%. Conclusion: The surgical outcome for patients with a prehospital diagnosis was better than for those without. The proposed agenda for RAAA treatment in the provinces is improvement of diagnostic ability at first-line medical institutions, cooperation and transportation between first-line and local base hospitals, and a system for efficient use of limited medical resources at local base hospitals.
