Bin Saif A; The Dudley Group NHS Foundation Trust, Dudley, UK.
Summerour V; Al-Saadi N; Arif A; Newman J; Wall M

Annals of Vascular Surgery. 109:522-530, 2024 Dec.

BACKGROUND: To investigate and analyze various aspects related to patients
who have been placed on a “turndown list” for elective or emergency repair
of abdominal aortic aneurysms.

METHODS: This retrospective study analyzed data from the Black Country
Vascular Network. Multidisciplinary team meetings assessed abdominal
aortic aneurysm patients referred through National Abdominal Aortic
Aneurysm Screening Program or directly to vascular surgery. Patients
considered unfit for intervention were added to a prospectively kept
turndown list. Survival and cause of death data were collected, along with
cardiopulmonary exercise testing (CPET) results and British Aneurysm
Repair scores for some patients. The study covered a period from January
2015 to May 2023.

RESULTS: After exclusions, 247 (16%) patients were placed on the turndown
list with a median age of 85 years (interquartile range 8 years). The
mortality of turndown cases on medical grounds was 74.1%. Survival was
significantly higher for patients who completed CPET before being turned
down (P = 0.004). Gender analysis revealed a higher proportion of females
being turned down compared to males (P = 0.044). COVID-19 led to a notable
reduction in the number of discussed cases and interventions, while the
turndown rates remained consistent. Survival at 1 year in turndown
patients was 66%, at 3 years it was 29%, at 4 years it was 18%, and at 7
years it was 5%. Most patients whose cause of death was known died of
respiratory complications (30%) or malignancy (19%). British Aneurysm
Repair scores and aneurysm size were not significant predictors of
mortality.

CONCLUSIONS: Patients on the turndown list have a substantial mortality
rate. A significant proportion of female patients were being turned down
compared to men and the reasons for this are not clear. Patients who
completed CPET before being turned down had a longer survival time. While
COVID-19 impacted healthcare services reducing the number of
interventions, it did not influence turndown decisions. The study showed
that the cause of death for a significant number of patients was
respiratory complications or malignancy