The Relationship Between Operative Volume and Peri-operative Mortality After Non-elective Aortic Aneurysm Repair in Australia

Abstract

WHAT THIS PAPER ADDSThis study is the first to have examined the effect of hospital and surgeon operative volume on mortality after nonelective aortic aneurysm repair in Australia. It was found that higher volume hospital caseload reduced mortality after open surgical aortic aneurysm repair, particularly in the emergency subgroup compared with the semi-urgent. These findings are consistent with studies from the UK and North America. There was no significant association between surgeon or hospital volume and mortality after non-elective endovascular aneurysm repair. These findings suggest that patients requiring emergency aneurysm surgery should be treated in high volume hospitals where possible.Objective: Hospital and surgeon operative caseload is thought to be associated with peri-operative mortality following the non-elective repair of aortic aneurysms; however, whether such an association exists within the Australian healthcare setting is unknown. Methods: The Australasian Vascular Audit was interrogated to identify patients undergoing non-elective (emergency [EMG] or semi-urgent [URG]) aortic aneurysm repair between 2010 and 2016, as well as their treating surgeon and hospital. Hierarchal logistic regression modelling was used to assess the impact of caseload on outcomes after both endovascular (EVAR) and open surgical repair (OSR). Results: Volume counts were determined from 14 262 patients (4 121 OSR and 10 141 EVAR). After exclusion of elective procedures and duplicates, 1 153 EVAR (570 EMG and 583 URG) and 1 245 OSR (946 EMG and 299 URG) non-elective cases remained for the analysis. Crude mortality was 24.0% following OSR (EMG 29.2%; URG 7.7%) and 7.5% following EVAR (EMG 12.6%; URG 2.4%). Univariable analysis demonstrated an association between OSR mortality and hospital volume (quintile [Q] 1: 25.

The Comparison of Endovascular and Open Surgical Treatment for Ruptured Abdominal Aortic Aneurysm in Terms of Safety and Efficacy on the Basis of a Single-Center 30-Year Experience

“…Their results revealed an inverse relationship between the overall hospital caseload but not the individual surgeon's caseload and perioperative mortality in the context of non-elective AAA repair. Of interest, the effect was observed within the emergency OR group, while the authors did not observe a volume-related mortality association in the case of EVAR [23]. Similar experiences have been reported by others; however, the survival benefit of centralised treatment of OR for rAAA was found to be particularly dependent on the positioning of the proximal clamp and vanished when controlled for this parameter [24].…”

Trends in AAA Repair in Australia Over Twenty Years

“…Numerous studies have established a link between surgeon volume of open aortic surgery and improved patient outcomes. [24][25][26][27] Geiger et al, in a recent analysis, identified that performing a minimum of seven open aortic procedures annually was a standalone predictor of better outcomes following OAR. 27 Our study demonstrated a significant decline in open procedures over the past two decades.…”