Epidemiological study of the relationship between volume and outcome after abdominal aortic aneurysm surgery in the UK from 2000 to 2005

Abstract

Increased annual volumes were associated with significant reductions in mortality for elective and urgent AAA repair, but not for repair of ruptured AAAs.

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

“…Historically, many district general (local) hospitals in the UK undertook emergency AAA surgery, but health regions in the UK now centralise vascular resources at a single tertiary hospital, because outcome for aortic surgery is better in high-volume compared with low-volume vascular centres [17]. Concomitant increases in the transfer time to hospital faced by patients with ruptured AAA do not appear to affect mortality adversely.…”

Volume versus Outcome When Treating Abdominal Aortic Aneurysm Electively — Is There Evidence to Centralise?

“…one is to bisect the material at the median and compareo utcome between the two groups (8,16). Another is to divide the material in similar sized groups, quartiles or quintiles (6, 10,12,16,17). Several studies use arbitrary divisions or expert opinion (2, 4, 5, 9, 11).…”

“…The average mortality of 7.7% was reached in centres performing only 14 elective repairs per year or more. Holt (16) …”

“…Seventeen other papers (model studies, studies on the effect of surgeon volume or specialization and others) werealso excluded. Thus 15 papers weret he base of the present study.T welve papers originated in north America (USA , Canada (15,16)) and three in Europe (UK (15,16),Germany (17)). reference lists provided one morerelevant US article (12).…”

Invited Commentary

“…Aliteratures earch of 20973 rAAAs by Laukontaus (3) disclosed that 12 studies had excluded patients unfit for surgery from analysis and that 14 studies considered one fourth of the patients moribund (weighted mean 24%, range 7-54%). Indeed, alarge epidemiological study on AAA surgery in the UK from 2000 to 2005 revealed that 7927 of 14389 rAAA werenot operated on, yielding atotal hospital mortality of 64.5% (4).…”