Improved In-Hospital Outcomes for a Ruptured Abdominal Aortic Aneurysm Over Time: A Single-Center Retrospective Analysis of 58 Cases

OBJECTIVE: At our institution, open surgical repair (OS) is the first-line treatment for ruptured abdominal aortic aneurysms (rAAA). This study aimed to evaluate in-hospital and long-term outcomes of rAAA treatment in a community hospital setting and to assess temporal changes in management, including operative delay (time to surgery), and survival. METHODS: We retrospectively analyzed 58 patients (mean age: 74 ± 9 years; male: n = 47) who underwent emergency surgery for rAAA between November 2012 and March 2025. OS was performed as the primary treatment strategy in 51 cases, whereas EVAR was selectively performed in seven hemodynamically stable patients with suitable anatomy when an appropriate stent-graft device was available. RESULTS: In-hospital mortality rate was 13/58 (22.4%), all in the OS group. Deaths were due to multiple organ failure (n = 6), sepsis (n = 3), bowel necrosis (n = 2), and hemorrhage (n = 2). Mortality rate decreased from 37.9% (11/29) in the early group to 6.9% (2/29) in the late group, with shorter time to surgery (median: 109 vs. 217 minutes; p = 0.01). The five-year survival rate was 58% ± 7%. CONCLUSION: A shorter time to surgery contributed to improved outcomes in patients with rAAA. Even when OS is adopted as the primary strategy, rapid surgical intervention can lead to favorable outcomes.