Structured Multidisciplinary Approach to Ruptured Abdominal Aortic Aneurysm: Impact on Mortality and Complications in a 13-Year Cohort
Issued Date
2025-09-01
Resource Type
eISSN
22288082
Scopus ID
2-s2.0-105016139004
Journal Title
Siriraj Medical Journal
Volume
77
Issue
9
Start Page
650
End Page
659
Rights Holder(s)
SCOPUS
Bibliographic Citation
Siriraj Medical Journal Vol.77 No.9 (2025) , 650-659
Suggested Citation
Puangpunngam N., Thanaisawanyangkoon N., Chinsakchai K., Ruangsetakit C., Wongwanit C., Hongku K., Tongsai S., Sermsathanasawadi N., Hahtapornsawan S., Prapassaro T., Pruekprasert K. Structured Multidisciplinary Approach to Ruptured Abdominal Aortic Aneurysm: Impact on Mortality and Complications in a 13-Year Cohort. Siriraj Medical Journal Vol.77 No.9 (2025) , 650-659. 659. doi:10.33192/smj.v77i9.276153 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/112232
Title
Structured Multidisciplinary Approach to Ruptured Abdominal Aortic Aneurysm: Impact on Mortality and Complications in a 13-Year Cohort
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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 of a multidisciplinary protocol for rAAA management at Siriraj Hospital. The study included 182 patients (pre-protocol: n=99, January 2010-December 2017; post-protocol: n=83, January 2018-March 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.