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Languages: English
Types: Article
Background— We aim to quantify the relationship between the annual caseload (volume) and outcome from elective endovascular (EVR) or open repair of abdominal aortic aneurysms (AAAs) in England between 2005 and 2007.\ud \ud Methods and Results— Individual patient data were obtained from the Hospital Episode Statistics. Statistical methods included multiple logistic regression models, mortality control charts, and safety plots to determine the nature of any relationship between volume and outcome. The case-mix between hospitals of different sizes was examined using observed and expected values for in-hospital mortality. Outcome measures included in-hospital mortality and hospital length of stay. Between 2005 and 2007, a total of 57 587 patients were admitted to hospitals in England with a diagnosis of AAA, and 11 574 underwent AAA repair. There were 7313 elective AAA repairs, of which 5668 (78%) were open and 1645 (22%) were EVR. In-hospital mortality rates were 5.63% for all elective AAA repairs with rates of 6.18% for open repair and 3.77% for EVR (odds ratio, 0.676; 95% CI, 0.501 to 0.913; P=0.011). High-volume aneurysm services were associated with significantly lower mortality rates overall (0.991; 0.988 to 0.994; P<0.0001), for open repairs (0.994; 0.991 to 0.998; P=0.0008), and EVR (0.989; 0.982 to 0.995; P=0.0007). Large endovascular units had low mortality rates for open repairs.\ud \ud Conclusion— A strong relationship existed between the volume of surgery performed and outcome from both open and endovascular aneurysm repairs. These data support the concept that abdominal aortic surgery should be performed in specialized units that meet a minimum volume threshold.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. Holt PJ, Poloniecki JD, Gerrard D, Loftus IM, Thompson MM. Meta-analysis and systematic review of the relationship between volume and outcome in abdominal aortic aneurysm surgery. Br J Surg. 2007;94:395- 403.
    • 2. Holt PJ, Poloniecki JD, Loftus IM, Michaels JA, Thompson MM. Epidemiological study of the relationship between volume and outcome after abdominal aortic aneurysm surgery in the UK from 2000 to 2005. Br J Surg. 2007;94:441- 448.
    • 3. Holt PJ, Poloniecki JD, Loftus IM, Thompson MM. Meta-analysis and systematic review of the relationship between hospital volume and outcome following carotid endarterectomy. Eur J Vasc Endovasc Surg. 2007;33:645- 651.
    • 4. Dimick JB, Upchurch GR Jr. Endovascular technology, hospital volume, and mortality with abdominal aortic aneurysm surgery. J Vasc Surg. 2008;47:1150 -1154.
    • 5. Department of Health. World Class Commissioning, 2008. http://www.dh.gov. uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/ DH_083204. Accessed December 12, 2008.
    • 6. Darzi A. High quality care for all: NHS Next Stage Review final report. In: Department of Health, editor: TSO, 30 June 2008;1-92.
    • 7. Department of Health. NHS Choices publishes surgery survival rates, 2008. http://www.nhs.uk/NHSEngland/Hospitalmortalityrates/Pages/ Data.aspx. Accessed 20th January 2009.
    • 8. Department of Health. Patient Choice, 2008. http://www.dh.gov.uk/en/ Healthcare/PatientChoice/DH_469. Accessed January 20, 2009.
    • 9. European Society for Vascular Surgery. First vascunet database report, 2007. http://www.esvs.org/files/Other_Committees/ESVS_VASCUNET_ REPORT_2007.pdf. Accessed July 17, 2009.
    • 10. BIBA Medical Ltd. http://www.cxvascular.com/bibamedical. Accessed July 17, 2009.
    • 11. Vascular Society of Great Britain and Ireland. National Vascular Database. http://www.vascularsociety.org.uk. Accessed July 17, 2009.
    • 12. Multicentre Aneurysm Screening Study Group. Multicentre aneurysm screening study (MASS): cost effectiveness analysis of screening for abdominal aortic aneurysms based on four year results from randomised controlled trial. BMJ. 2002;325:1135-1141.
    • 13. Ashton HA, Buxton MJ, Day NE, Kim LG, Marteau TM, Scott RA, et al. The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet. 2002;360:1531-1539.
    • 14. Holt PJ, Poloniecki JD, Hinchliffe RJ, Loftus IM, Thompson MM. Model for the reconfiguration of specialized vascular services. Br J Surg. 2008; 95:1469 -1474.
    • 15. Holt PJE, Poloniecki JD, Loftus IM, Thompson MM. Demonstrating safety through in-hospital mortality following elective repair of abdominal aortic aneurysm in England. Br J Surg. 2007;95:64 -71.
    • 16. Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128 -1137.
    • 17. Dimick JB, Stanley JC, Axelrod DA, Kazmers A, Henke PK, Jacobs LA, et al. Variation in death rate after abdominal aortic aneurysmectomy in the United States: impact of hospital volume, gender, and age. Ann Surg. 2002;235:579 -585.
    • 18. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG, EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet. 2004;364: 843- 848.
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