Has the Centralization of Vascular Services changed the 30-day mortality in Elective Abdominal Aortic Aneurysm (AAA) repairs in North Wales?

Ann Vasc Surg. 2025 May 5:S0890-5096(25)00315-2. doi: 10.1016/j.avsg.2025.04.121. Online ahead of print.

ABSTRACT

THE BACKGROUND: North Wales Vascular Services were centralized to Glan Clwyd hospital in 2019 with the establishment of a new hybrid vascular theatre. Several studies have demonstrated the efficacy of centralization of such services in the country. However, there were no previous studies done with regard to the status of North Wales. This study aimed to assess any significant difference in 30-day/ in-hospital mortality and the immediate cause of death following elective AAA repairs done before and after centralization of services in April 2019.

METHODOLOGY: All the elective AAA surgeries (open and endovascular) were included from April 2014 to April 2024 while excluding the emergency surgeries done for ruptured AAA. The retrospective data were extracted from Betsi Cadwaladr University Health Board (BCUHB) digital operative records, Welsh Clinical Portal (WCP), case notes, death certificates, and Coroner reports. The Chi-square test for independence was used to assess any significance of mortality rates with centralization status. A detailed analysis of multivariable correlation analysis of centralization status was done with mortality rate, age and sex.

RESULTS: A total of 437 elective AAA records were scrutinized during the study period. Overall, 30-day mortality for elective AAA repairs done before and after centralization was 4% (N=252) and 3% (N=185) respectively with p value of 0.69. OSR mortality slightly increased due to the relatively small numbers, far-reaching conclusions cannot be drawn. There were no EVAR deaths after centralization. The main immediate causes of death were myocardial infarction, multi-organ failure (MOF) and pulmonary embolism.

CONCLUSION: There is no statistical significance deference in overall death rates despite of centralization status. However, the EVAR has zero 30-day mortality after centralization which means an immediately apparent clinical difference in the EVAR group.

PMID:40334978 | DOI:10.1016/j.avsg.2025.04.121