Kurzfassung S3-Leitlinie zu Screening, Diagnostik, Therapie und Nachsorge des Bauchaortenaneurysmas

Debus, Eike Sebastian; Heidemann, Franziska; Gross-Fengels, W.; Mahlmann, Adrian; Muhl, Elke; Pfister, Karin; Roth, S.; Stroszczynski, Christian; Walther, Andreas; Weiss, Norbert; Wilhelmi, Mathias; Grundmann, Reinhart T.

doi:10.1007/s00772-018-0435-3

Cited by 38 publications

(11 citation statements)

References 108 publications

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“…This number is not specified regarding OR or EVAR. The German S3 guidelines [2] discuss minimum case numbers deduced from a number of meta-analyses and single studies. These differ between 8 and 60 cases per year and in most cases do not discriminate between OR and EVAR.…”

Section: Discussionmentioning

confidence: 99%

“…Current national and international guidelines recommend elective repair of infrarenal abdominal aortic aneurysms (AAA) for prevention of rupture and embolism depending on the maximum transverse diameter of the aneurysm and on the physical status and comorbidities of the patient [1,2]. Repair can be done as an open (OR) or an endovascular (EVAR) approach.…”

Section: Background and Aimmentioning

confidence: 99%

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Association between operation volume and postoperative mortality in the elective open repair of infrarenal abdominal aortic aneurysms: systematic review

et al. 2020

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Background An inverse association between the case volume per hospital and surgeon and perioperative mortality has been shown for many surgical interventions. There are numerous studies on this issue for the open treatment of infrarenal aortic aneurysms. Aim To present the available data on the association between the case volume per hospital and surgeon and perioperative mortality in the elective open repair of infrarenal aortic aneurysms in a systematic review. Materials and methods Using the PubMed, Cochrane Library, Web of Science Core Collection, CINAHL, Current Contents Medicine (CCMed), and ClinicalTrials.gov databases, a systematic search was performed using defined keywords. From the search results, all original papers were included that compared the elective open repair of an infrarenal aortic aneurysm in a “high volume” center with a “low volume” center or by a “high volume” surgeon with a “low volume” surgeon, as defined in the respective study. Results After deduplication, the literature search yielded 1021 hits of which 60 publications met the inclusion criteria. Of these, 37/43 studies showed a lower mortality in “high volume” compared to “low volume” centers and 14/17 comparisons showed a lower mortality for “high volume” compared to “low volume” surgeons. The effect measures, usually odds ratios, ranged from 0.37 to 0.99 for volume per hospital and 0.31 to 0.92 for volume per surgeon. Regarding the threshold values for the definition of “high volume” and “low volume,” a clear heterogeneity was shown between the individual studies. Discussion The available data on the association between the case volume per hospital and surgeon and perioperative mortality in the elective open repair of infrarenal aortic aneurysms show that interventions performed in “high volume” centers or by “high volume” surgeons are associated with lower mortality. To ensure the best possible outcome in terms of low perioperative mortality in the open repair of infrarenal aortic aneurysms, the aim should be centralization with high case volume per hospital and surgeon.

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Section: Discussionmentioning

confidence: 99%

Section: Background and Aimmentioning

confidence: 99%

Association between operation volume and postoperative mortality in the elective open repair of infrarenal abdominal aortic aneurysms: systematic review

et al. 2020

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“…This number is not specified regarding OR or EVAR. The German S3 guidelines [33] discuss minimum case numbers deduced from a number of meta-analyses and single studies. These range from eight to 60 annual cases and are mostly not presented specifically for OR or EVAR.…”

Section: Diskussionmentioning

confidence: 99%

Association between operation volume and postoperative mortality in elective endovascular repair of infrarenal abdominal aortic aneurysms: systematic review—continuation

et al. 2020

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Background Many surgical interventions show an inverse association between case volume per hospital/surgeon and perioperative mortality. In the first part of this systematic review it was shown that such an association also exists for the open treatment of infrarenal aortic aneurysms. The second part now examines a possible association with endovascular treatment of infrarenal aortic aneurysms. Objective In a systematic review, the data available on the association between the case volume per hospital/surgeon and perioperative mortality in elective endovascular treatment of infrarenal aortic aneurysms are presented. Materials and Methods Systematic research using defined keywords was carried out. All original works comparing elective endovascular treatment of an infrarenal aortic aneurysm in a “high volume” center with a “low volume” center or by a “high volume” surgeon with a “low volume” surgeon, as defined in each study, were included. Results After deduplication, the literature search produced 1,021 hits. Of these, 16 publications fulfilled the inclusion criteria. With regard to the thresholds for the definition of high volume and low volume, there was marked heterogeneity between individual studies. Twelve of the 15 studies showed a significantly lower mortality in high volume than in low volume centers. The effect measures, usually odds ratios, were between 0.43 and 0.91. In the comparison between high volume and low volume surgeons, there was no difference in mortality in any of the five studies included. Discussion The available data on the association between case volume per hospital and surgeon and the perioperative mortality in elective endovascular treatment of infrarenal aortic aneurysms consistently show that patients operated on in high volume centers have a lower mortality. The volume per surgeon seems to have no influence on perioperative mortality. To achieve the lowest perioperative mortality possible in endovascular treatment of infrarenal aortic aneurysms, centralization with high volume per hospital should be aimed for, taking into consideration the context of the health care system.

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“…Die derzeit gültigen nationalen und internationalen Leitlinien empfehlen die elektive Ausschaltung infrarenaler abdomineller Aortenaneurysmen (AAA) zur Ruptur-und Embolieprophylaxe in Abhängigkeit vom maximalen Transversaldurchmesser des Aneurysmas sowie von Allgemeinzustand und Begleiterkrankungen des Patienten [1,2]. Die Ausschaltung kann entweder als offene (OR) oder als endovaskuläre (EVAR) Operation erfolgen.…”

Section: Hintergrund Und Fragestellungunclassified

Assoziation zwischen Operationsvolumen und postoperativer Mortalität bei der elektiven offenen Versorgung infrarenaler abdomineller Aortenaneurysmen: systematische Übersichtsarbeit

et al. 2020

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Kurzfassung S3-Leitlinie zu Screening, Diagnostik, Therapie und Nachsorge des Bauchaortenaneurysmas

Cited by 38 publications

References 108 publications

Association between operation volume and postoperative mortality in the elective open repair of infrarenal abdominal aortic aneurysms: systematic review

Association between operation volume and postoperative mortality in the elective open repair of infrarenal abdominal aortic aneurysms: systematic review

Association between operation volume and postoperative mortality in elective endovascular repair of infrarenal abdominal aortic aneurysms: systematic review—continuation

Assoziation zwischen Operationsvolumen und postoperativer Mortalität bei der elektiven offenen Versorgung infrarenaler abdomineller Aortenaneurysmen: systematische Übersichtsarbeit

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