The effect of hospital factors on mortality rates after abdominal aortic aneurysm repair

Dua, Anahita; Furlough, Courtney L.; Ray, Hunter M.; Sharma, Satyasheel; Upchurch, Gilbert R.; Desai, Sapan S.

doi:10.1016/j.jvs.2014.08.111

Cited by 49 publications

(25 citation statements)

References 21 publications

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“…The influence of volume on surgical outcomes has been seen with some procedures. 22 Volume does affect the rate of CVA, MI, and death after CAS. Low-volume surgeons who perform only one or two cases per year have a 2.52 to 5.78 times increase in risk of complications or death after CAS compared with surgeons who perform three or more cases per year, which is similar to findings from another recent study.…”

Section: Discussionmentioning

confidence: 99%

Predictors of poor outcome after carotid intervention

Dua

Romanelli

Upchurch

et al. 2016

Journal of Vascular Surgery

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Higher rates of postoperative stroke and inpatient mortality for women undergoing CAS is an unexpected finding, and may indicate that this population is vulnerable to complications after endovascular management. Low volume is a predictor of complications and subsequent mortality primarily for CAS. Patients who undergo CEA continue to have superior outcomes compared with matched cohorts who undergo CAS.

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Section: Discussionmentioning

confidence: 99%

Predictors of poor outcome after carotid intervention

Dua

Romanelli

Upchurch

et al. 2016

Journal of Vascular Surgery

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“…The association between hospitals with higher annual procedure volume and improved survival has been demonstrated for most major surgical procedures . Better patient outcomes at higher volume centers have also been reported for percutaneous cardiovascular interventions, such as coronary and valvular procedures, peripheral arterial interventions, and endovascular aortic repair (EVAR) . Building on these findings, several studies have shown that increasing referral of elective EVAR cases to high‐volume centers by a process known as regionalization leads to improved patient outcomes .…”

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confidence: 94%

Hospital volume and mortality after transjugular intrahepatic portosystemic shunt creation in the United States

et al. 2017

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“…EVAR proficiency has been attributed to both increased institutional and surgeon volume. 18–21 Similarly, good open aneurysm repair outcomes correlate with increasing surgeon and hospital volume. 22–25 As inexperienced individual surgeons and institutions get faced with tough open repairs, increasingly they may pass on treating the patient.…”

Section: Discussionmentioning

confidence: 97%

National temporal trends and determinants of cost of abdominal aortic aneurysm repair

et al. 2020

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Introduction In recent decades, there has been a shift in the management of aortic abdominal aneurysm from open intervention (open aortic aneurysm repair) to an endovascular approach (endovascular aortic aneurysm repair). This shift has yielded clinical as well as socioeconomic reverberations. In our current study, we aim to analyze these effects brought about by the switch to endovascular treatment and to scrutinize the determinants of cost variations between the two treatment modalities. Methods The National (Nationwide) Inpatient Sample database was queried for clinical data ranging from 2001 to 2013 using International Classification of Disease, 9th Revision (ICD-9) codes for open and endovascular aortic repair. Clinical parameters and financial data related to the two treatment modalities were analyzed. Temporal trends of index hospitalization costs were determined. Multivariate linear regression was used to characterize determinants of cost for endovascular aneurysm repair and open abdominal aortic aneurysm repair. Results A total of 128,154 aortic repairs were captured in our analysis, including 62,871 open repairs and 65,283 endovascular repairs. Over the assessed time period, there has been a decrease in the cost of elective endovascular aortic aneurysm repair from $34,975.62 to $31,384.90, a $3,590.72 difference ( p < 0.01), while the cost of open aortic repair has increased from $37,427.77 to $43,640.79 by 2013, a $6,212.79 increase ( p < 0.01). The cost of open aortic aneurysm repair disproportionately increased at urban teaching hospitals, where by 2013, it costs $50,205.59, compared to $34,676.46 at urban nonteaching hospitals, and $34,696.97 at rural institutions. Urban teaching hospitals were found to perform an increasing proportion of complex open aneurysm repairs, involving concomitant renal and visceral bypass procedures. On multivariate analysis, strong determinants of cost increase for both endovascular aortic aneurysm repair and open aortic aneurysm repair are rupture status, prolonged length of stay, occurrence of complications, and the need for disposition to a nursing facility or another acute care institution. Conclusion As the vascular community has shifted from an open repair of abdominal aortic aneurysm to an endovascular approach, a number of unforeseen clinical and economic effects were noted. We have characterized these ramifications to help guide further clinical decision and resource allocation.

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The effect of hospital factors on mortality rates after abdominal aortic aneurysm repair

Cited by 49 publications

References 21 publications

Predictors of poor outcome after carotid intervention

Predictors of poor outcome after carotid intervention

Hospital volume and mortality after transjugular intrahepatic portosystemic shunt creation in the United States

National temporal trends and determinants of cost of abdominal aortic aneurysm repair

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