Characteristics, treatments, and outcomes among patients with abdominal aortic injury in Japan: a nationwide cohort study

BACKGROUND: Abdominal aortic injury (AAI) is a life-threatening condition that occurs in only 0.1% of all trauma admissions. Because of its rarity, the clinical features of AAI remain unclear. We investigated the characteristics, treatments, and clinical outcomes among patients with AAI. METHODS: This retrospective cohort study was performed using the Japanese Diagnosis Procedure Combination database. We identified patients with a confirmed diagnosis of AAI with emergency admission from 1 July 2010 to 31 March 2017. Eligible patients were divided into three groups: those who were treated with no surgery or endovascular treatment (non-repair group), those who underwent surgery without endovascular treatment (open repair group), and those who received endovascular treatment without surgery (endovascular repair group). RESULTS: A total of 238 patients met the inclusion criteria during the study period. Of these, 191 (80.3%) were allocated to the non-repair group, 20 (8.4%) were allocated to the open repair group, and 27 (11.3%) were allocated to the endovascular repair group. The proportions of patients in the non-repair group from July 2010 to March 2012, April 2012 to March 2014, April 2014 to March 2016, and April 2016 to March 2017 were 93.5%, 75.9%, 80.6%, and 73.2%, respectively. The crude in-hospital mortality rate was 26.2%, 35.0%, and 18.5% in the non-repair, open repair, and endovascular repair group, respectively. CONCLUSIONS: In this cohort, the proportion of non-repair for AAI decreased from 2010 to 2017, whereas the proportion of endovascular repair increased. Younger patients were more likely to undergo open repair, whereas older patients were more likely to undergo endovascular repair.