Hospital volume-related differences in aorto-bifemoral bypass operative mortality in the United States

Abstract

AFB operative mortality was significantly lower at high-volume hospitals in this nationally representative database. The effect of hospital volume of AFB procedures on outcome should be of importance to patients, providers, and health policy makers.

Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease

“…This finding represents a strong argument for conservative treatment, percutaneous transluminal angioplasty, or extra-anatomic reconstruction in this patient group. We were unable to demonstrate a hospital caseloadrelated variation in early outcome as reported by Dimick et al 9 Our range of 30-day mortality was, however, smaller and we included fewer institutions than Dimick et al We were, nevertheless, still able to demonstrate significant variation (from 5% to 17%) in mortality after major complications among hospitals. This fact and the generally high incidence of cardiopulmonary complications emphasizes that the focus in open aortic surgery should be not only on how to prevent complications but also how to discover and effectively treat these inevitable complications.…”

Surgical Technique and Peripheral Artery Disease

“…42 Nationally, the mortality rate is 3.7% at lower-volume centers and 2.2% at highvolume centers. 6 In medically compromised patients, who typically are older and have advanced limb ischemia, a history of previous lower-extremity inflow operations, chronic kidney dysfunction, severe chronic obstructive pulmonary disease, or severe CAD, extra-anatomic bypass is a reasonable alternative to direct reconstruction. 5 A procedure commonly used in this setting is the axillofemoral bypass in which inflow is derived from the axillary artery ( Figure 3A).…”

“…5 Mortality after direct aortic reconstruction is increased in patients Ͼ65 years of age and in those with chronic obstructive pulmonary disease who undergo operation at a lowvolume center. 6 Surgical mortality after lower-extremity bypass for Medicare patients treated between 1994 and 1999 in high-volume hospitals was 4.1%. 7 In the Project or Ex-Vivo Vein Graft Engineering via Transfection (PREVENT) III trial, which examined outcomes in 1404 patients who underwent infrainguinal bypass for limb salvage, the 30-day mortality was 2.7%, myocardial infarction (MI) rate was 4.7%, and rate of stroke/transient ischemic attack was 1.4%.…”

Prevalence and risk factors of fatal myocardial infarction in emergency abdominal surgery

“…Полученные нами результаты в целом соответствуют данным литературы. В частности, показано, что возраст 65-75 лет и более явля-ется независимым фактором риска ИМ и любых сердечно-сосудистых осложнений при различных некардиальных вмешательствах [6,[9][10][11][12][13][14][15][16], а также фактором риска общей летальности при экстренных абдоминальных вмешатель-ствах [17]. Кроме того, следующие факторы также ассоции-ровались с повышенным риском ИМ, других периопера-ционных сердечно-сосудистых осложнений и общей смертности: женский пол [12]; стенокардия напряжения [18] и ИБС вообще [9,11,19]; АГ [6], а также АГ 3-й степе-ни [20]; предоперационные изменения ЭКГ -патологиче-ский зубец Q [21][22][23] и изменения ST-T [23][24][25]; легочная патология [10,13]; анемия [6,19,26] и СД [21,[27][28][29].…”