Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000-2015)

Objective: Ruptured abdominal aortic aneurysm (rAAA) is a lethal condition that requires acute repair to prevent death. This analysis aims to assess the nationwide trends in rAAA admission, repair and mortality in a country, Portugal, without national screening for AAA. Methods: rAAA registered in the hospital administrative database of the National Health Service and all nationally registered deaths due to rAAA based on death certificate data were analysed. Three time periods (2000-2004, 2005-2009, and 2010-2015) were compared in patients >= 50 years old to assess the variations over time. Results: A total of 2 275 patients >= 50 years old with rAAA were identified in the two databases from 2000 to 2015. The age standardised incidence of rAAA was 2.78 +/- 0.24/100 000/year in 2000-2004, 3.17 +/- 0.39/100 000/year in 2005-2009 and 3.21 +/- 0.28/100 000/year in 2010-2015 (p < .001). When comparing the time periods 2000-2004 to 2005-2009, the age standardised rate of admission (n = 1460) increased from 1.57 +/- 0.25/100 000/year to 2.24 +/- 0.32/100 000/year (p < .001). The operative mortality rates decreased during this time period (from 55.3 +/- 4.7% to 48.8 +/- 4.7%, p < .001). In 2010-2015, the age standardised rate of admissions due to rAAA decreased (1.98 +/- 0.22/100 000/year). Operative mortality remained stable (48.9 +/- 6.2%). The rate of patient deaths outside the hospital decreased from the first to the second period (1.21 +/- 0.10/100 000/year and 0.93 +/- 0.29/100 000/year, respectively) but later increased (1.14 +/- 0.22/100 000/year). This resulted in a higher overall rAAA related mortality in Portugal in the third period (2.20 +/- 0.18/100 000/year, 2.21 +/- 0.27/100 000/year and 2.26 +/- 0.26/100 000/year in 2000-2004, 2005-2009, and 2010-2015, respectively, p < .001). Conclusion: Overall, the incidence of rAAA in Portugal has been stable over the past 10 years. The rates of admission, repair, and death due to rAAA repair seem to have reached an inflection point and are now decreasing. Mortality outside the hospital remains a matter of concern, warranting further planning of streamlined transfer networks and vascular surgical departments.