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

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.