Association Between Hospital Volume and Failure to Rescue After Open or Endovascular Repair of Intact Abdominal Aortic Aneurysms in the VASCUNET and International Consortium of Vascular Registries

Abstract

Objective: To investigate the association between hospital volume and failure to rescue (FtR), after open repair (OAR), and endovascular repair (EVAR) of intact abdominal aortic aneurysms (AAA) among centers participating in the VASCUNET and International Consortium of Vascular Registries. Summary of Background Data: FtR (ie, in-hospital death following major complications) is a composite end-point representing the inability to treat complications effectively and prevent death. Methods: Using data from 8 vascular registries, complication and mortality rates after intact AAA repair were examined (n = 60,273; EVAR-43,668; OAR-16,605). A restricted analysis using pooled data from 4 countries (Australia, Hungary, New Zealand, and USA) reporting data on all postoperative complications (bleeding, stroke, cardiac, respiratory, renal, colonic ischemia) was performed to identify risk-adjusted association between hospital volume and FtR. Results: The most frequently reported complications were cardiac (EVAR-3.0%, OAR-8.9%) and respiratory (EVAR-1.0%, OAR-5.7%). In adjusted analysis, 4.3% of EVARs and 18.5% of OARs had at least 1 complication. The overall FtR rate was 10.3% after EVAR and 15.7% after OAR. Subjects treated in the highest volume centers (Q4) had 46% and 80% lower odds of FtR after EVAR (OR = 0.54; 95% CI = 0.34–0.87; P = 0.04) and OAR (OR = 0.22; 95% CI = 0.11–0.44; P < 0.001) when compared to lowest volume centers (Q1), respectively. Colonic ischemia had the highest risk of FtR for both procedures (adjusted predicted risks, EVAR: 27%, 95% CI 14%–45%; OAR: 30%, 95% CI 17%–46%). Conclusions: In this multi-national dataset, FtR rate after intact AAA repair with EVAR and OAR is significantly associated with hospital volume. Hospitals in the top volume quartiles achieve the lowest mortality after a complication has occurred.

Association of Hospital Volume with Perioperative Mortality of Endovascular Repair of Complex Aortic Aneurysms

“…It is described that in intact AAA-repairs, an increase in hospital volume is significantly associated with less failure to rescue, which could be caused due to prompt recognition and management of complications in large volume hospitals. 31 Spinal cord ischemia as well as cerebral embolism are the most feared complications following management of thoracic aortic aneurysms 15 and complex aortic aneurysms. 37 Previous studies have reported paraplegia rates of 4.1% and 5.2% following FEVAR and BEVAR, 27,37 which is in accordance with our present results.…”

“…It is described that in intact AAA-repairs, an increase in hospital volume is significantly associated with less failure to rescue, which could be caused due to prompt recognition and management of complications in large volume hospitals. 31…”

“…18 Several studies have shown associations between the number of aortic interventions and outcomes. 12,13,31 Since infrarenal endovascular aneurysm repair has been centralized in the United Kingdom, mortality rates following these interventions have dropped from 1.5% to 0.9% following EVAR and from 5.4% to 4.0% following OSR. 11 Defining the optimal threshold or cut-off is difficult and might differ between countries.…”

Midterm Results of Iliac Branch Devices in a Newly Established Aortic Center

“…A recent Dutch analysis also showed a significant effect of hospital volume on perioperative mortality following complex EVAR, with high volume centers demonstrating decreased mortality rates [ 30 ]. D’Oria et al investigated the association between hospital volume and failure to rescue after EVAR and open aortic repair of intact abdominal aortic aneurysms and found a significant association: hospitals in the top volume quartiles achieve the lowest mortality after a complication has occurred [ 31 ].…”

Peri-Operative Management of Patients Undergoing Fenestrated-Branched Endovascular Repair for Juxtarenal, Pararenal and Thoracoabdominal Aortic Aneurysms: Preventing, Recognizing and Treating Complications to Improve Clinical Outcomes

“…Lately, the concept of failure to rescue (which is a composite endpoint defined as peri-operative death after experiencing at least one major complication) has emerged as an additional and more sensitive marker for team quality assessment in aortic interventions. Future research may also be directed toward better understanding of failure to rescue after complex endovascular aortic repair, as this remains relatively unaddressed in the available literature [ 31 ].…”