National Trends in the Repair of Ruptured Abdominal Aortic Aneurysms

Objective: Despite advances in treatment of abdominal aortic aneurysms (AAA) and the advent of screening for AAA, ruptured AAA (rAAA) remain a challenging problem. In this study, we evaluate trends in diagnosis and treatment of rAAA in the United States Medicare population.
Methods: The Medicare beneficiary database (1995 through 2004) was reviewed for patients with rAAA and elective AAA. ICD-9 codes for AAA, rAAA and associated procedures identified patients within the database. Proportions and trends were analyzed by chi-square analysis and continuous variables by Student's t-test.
Results: The number of patients hospitalized with diagnoses of rAAA declined from .234 to .144 per 1000 capita (p < .0001), as did repairs performed for rAAA (.158 to .096 per 1000 capita; p < .0001). Mortality after repair of rAAA also recently diminished (46.0% in 2000; 41.8% in 2004; p < .05). Moreover, we found the demographics of patients treated for rAAA changed to include a greater proportion of women and the elderly. No per capita change was observed in elective AAA repairs, which would be expected if early identification and elective repair were responsible for the decrease in rAAA.
Conclusion: A significant decrease was observed in the number of patients diagnosed and treated for rAAA. Surprisingly, this decrease is unrelated to changes in elective AAA repairs, suggesting pharmaceutical therapies may play an important role in aneurysm stabilization.