Structured Multidisciplinary Approach to Ruptured Abdominal Aortic Aneurysm: Impact on Mortality and Complications in a 13-Year Cohort

Nattawut  Puangpunngam; Nattharuethai  Thanaisawanyangkoon; Khamin Chinsakchai; Chanean  Ruangsetakit; Chumpol  Wongwanit; Kiattisak  Hongku; Sasima  Tongsai; Nuttawut  Sermsathanasawadi; Suteekhanit  Hahtapornsawan; Tossapol  Prapassaro; Kanin  Pruekprasert

doi:10.33192/smj.v77i9.276153

Authors

Nattawut Puangpunngam Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Nattharuethai Thanaisawanyangkoon Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Khamin Chinsakchai Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Chanean Ruangsetakit Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Chumpol Wongwanit Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Kiattisak Hongku Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Sasima Tongsai Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Nuttawut Sermsathanasawadi Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Suteekhanit Hahtapornsawan Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Tossapol Prapassaro Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Kanin Pruekprasert Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

DOI:

https://doi.org/10.33192/smj.v77i9.276153

Keywords:

Ruptured AAA, Protocol, Multidisciplinary team, Outcomes, Perioperative mortality

Abstract

Objective: To evaluate the impact of a comprehensive multidisciplinary protocol on 30-day survival in ruptured abdominal aortic aneurysm (rAAA) patients and to identify factors influencing outcomes.

Materials and Methods: We conducted a retrospective study comparing outcomes before and after implementation a multidisciplinary protocol for rAAA management at Siriraj Hospital. The study included 182 patients (pre-protocol: n=99, Jan 2010-Dec 2017; post-protocol: n=83, Jan 2018-Mar 2023). Primary outcome was 30-day overall survival, with secondary outcomes including factors influencing survival, need for aortic balloon occlusion, operative parameters, length of stay, and complications.

Results: The 30-day mortality rate significantly decreased from 16.2% pre-protocol to 6.0% post-protocol (p=0.037). Kaplan-Meier analysis showed improved 30-day survival in the post-protocol group (94.0% vs 83.8%, p=0.034). However, while protocol implementation was associated with a non-significant reduction in mortality hazard (adjusted HR 0.509, 95% CI 0.175-1.478, p=0.213), multivariable analysis identified cardiac arrest (aHR 8.180, p<0.001) and unfit patient status (aHR 6.420, p=0.003) as independent predictors of mortality. The post-protocol group had significantly reduced myocardial ischemia (7.2% vs 21.2%, p=0.015) and septicemia (1.2% vs 20.2%, p<0.001), with no significant differences in operative parameters or length of stay.

Conclusion: Implementation of a multidisciplinary protocol for rAAA management was associated with improved 30-day survival and reduced postoperative complications, supporting the use of structured protocols in rAAA management.

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