Andreas Reite has studied the prevalence, mortality and value of risk scoring systems in ruptured abdominal aortic aneurysms.
MAIN RESULTS:
- 90-day mortality from ruptured abdominal aortic aneurysms in Western Norway is 68 %.
- 90-day survivors have comparable long-term mortality to the general population.
- Risk scoring systems have limited accuracy in predicting outcome following ruptured abdominal aortic aneurysms.
THESIS DEFENCE:
Thesis: Epidemiology, Risk Assesment and Outcomes in Ruptured Abdominal Aortic Aneurysms.
Candidate: Andreas Reite
Time: June 6, 2019 at 12:15
Place: Stavanger University Hospital, Sydbygget: Aula
Link to university website (in Norwegian)
SUMMARY:
(1) From 2000 to 2012, Reite and co-workers identified 216 persons with ruptured abdominal aortic aneurysms in the catchment area of Stavanger University Hospital. This corresponds to an incidence rate of 11 per 100,000 per year, which did not change throughout the period.
79 % of those affected were men. Among the 196 individuals treated at the hospital, 52 died without receiving surgery. 16 of the 144 surgically treated patients died from blood loss. Within 90 days, 51 % of those treated at the hospital were dead. Including the 20 out-of-hospital deaths, the total 90-day mortality was 68 %. The mortality rate was stable during the decade.
(2) None of the four most commonly used methods to assess risk of death in patients with ruptured abdominal aortic aneurysms are very accurate, according to Reite’s second paper. Among 177 surgically treated patients, nearly half died within 30 days. The area under a ROC curve for three of the methods was 0.68, and only 0.59 for the last method, indicating a slightly better ability to discriminate survivors and nonsurvivors than by chance only. The evaluated methods were Hardman Index, Vancouver Score, updated Glasgow Aneurysm Score and Edinburgh Ruptured Aneurysm Score. The findings question the clinical value of these scoring systems for deciding treatment following ruptured abdominal aortic aneurysms.
(3) Doomed not fit for surgery and not wanting surgery are among the main reasons for not operating admitted patients with a ruptured abdominal aortic aneurysm. The other half of non-operated patients were either dying or agonal at the time of diagnosis, or diagnosed after their death. The researchers evaluated 57 patients who did not undergo surgery, constituting 27 % of the total population of hospital-admitted patients with ruptured abdominal aortic aneurysms in the Stavanger area between 2000 and 2014.
(4) Currently unpublished data shows good long-term survival in the limited number of patients surviving the first 90 days after a ruptured abdominal aortic aneurysm. Survival was not significantly different from what is expected in the general population.
REFERENCES:
(1) Reite, A., Søreide, K., Ellingsen, C. L., Kvaløy, J. T., & Vetrhus, M. (2015). Epidemiology of ruptured abdominal aortic aneurysms in a well-defined Norwegian population with trends in incidence, intervention rate, and mortality. Journal of vascular surgery, 61(5), 1168-1174.
(2) Reite, A., Søreide, K., & Vetrhus, M. (2017). Comparing the accuracy of four prognostic scoring systems in patients operated on for ruptured abdominal aortic aneurysms. Journal of vascular surgery, 65(3), 609-615.
(3) Vetrhus, M., Reite, A., Vennesland, J. B., & Søreide, K. (2018). Characteristics, stratification and time to death in a population-based cohort of patients with ruptured abdominal aortic aneurysms not undergoing surgery. World journal of surgery, 42(7), 2269-2276.
