Impact of hospital volume and type on outcomes of open and endovascular repair of descending thoracic aneurysms in the United States Medicare population

Patel, Virendra I.; Mukhopadhyay, Shankha; Ergül, Emel; Aranson, Nathan J.; Conrad, Mark F.; LaMuraglia, Glenn M.; Kwolek, Christopher J.; Cambria, Richard P.

doi:10.1016/j.jvs.2013.01.035

Cited by 54 publications

(25 citation statements)

References 24 publications

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“…Although to our knowledge the association between hospital volume and patient outcomes has begun to be examined only recently for patients with sarcomas, it has been extensively examined across other patient populations. [6][7][8]11,20,26 Compared with treatment at LVHs, treatment at HVHs has been associated with improved patient outcomes after various complex oncologic resections, including head and neck surgery, 12 esophagectomy, 9,15,16 colorectal surgery, 9,17,27 HPB,9,19,20,28 cystectomy, 13 nephrectomy, 10 and major lung resection. 14 The relationship between hospital volume and patient outcomes may reflect differences in multiple aspects of the multidisciplinary care of the oncology patient undergoing complex surgical resection, such as the patient with primary resectable RPS.…”

Section: Discussionmentioning

confidence: 99%

Treatment at low‐volume hospitals is associated with reduced short‐term and long‐term outcomes for patients with retroperitoneal sarcoma

Keung

Chiang

Cormier

et al. 2018

Cancer

111

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Background Retroperitoneal sarcomas (RPS) are rare tumors for which complete surgical resection remains the mainstay of treatment. We sought to determine the impact of hospital case volume on RPS outcomes. Methods We identified 6950 patients with primary RPS who underwent surgical resection from the National Cancer Data Base (1998–2011). Treating hospitals were classified by annual case volume; low volume hospitals (LVHs) and high volume hospitals (HVHs) were defined as ≤10 and >10 cases/year, respectively. Overall survival (OS) was compared using Kaplan-Meier curves. Cox proportional hazard models were created to compare risks. Results Of 1131 reporting hospitals, most (n=1127, 99.6%) were LVHs treating the majority of patients (n=6270; 90.2%). Patients treated at LVHs were more likely to have lower grade and smaller tumors, receive radiation therapy, and undergo incomplete gross (R2) resection. Patients treated at HVHs had lower 30-day readmission rates (1.8% vs 3.4%, p<0.001), 30-day (1.9% vs 3.1%, p=0.004) and 90-day mortality (3.2% vs 5.7%, p=0.007); longer median OS (76.2 vs 64.2 months, p<0.001) and higher 5-year OS (58% vs 52%, p<0.001). After controlling for age, gender, insurance status, tumor size, tumor grade, resection margin status, and radiation administration, treatment at a HVH was independently associated with a reduced risk of death (HR 0.77, 95% CI 0.65–0.91, p=0.003). Conclusion Primary RPS are rare tumors for which few surgeons and institutions have significant experience and expertise in their multidisciplinary management and surgical resection. Although additional studies are needed, patient outcomes may be impacted by treating facility case volume and experience.

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Section: Discussionmentioning

confidence: 99%

Treatment at low‐volume hospitals is associated with reduced short‐term and long‐term outcomes for patients with retroperitoneal sarcoma

Keung

Chiang

Cormier

et al. 2018

Cancer

111

View full text Add to dashboard Cite

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“…This has been consistent with recent reports on the population studies. [12][13][14] Of considerable interest was the effect of endovascular option on the risk profile of aneurysms that continued to be treated with open repair. Although this effect was difficult to measure directly, to assess the potential effect of case complexity, we divided our surgical cohort …”

Section: Discussionmentioning

confidence: 99%

“…2 Since that report, we observed that the presenting disposition of our patients has changed, which may have been the result of the shift from open to endovascular treatments of the thoracic aorta. [12][13][14] In addition, our technique has evolved, incorporating changes in monitoring and organ protection. [15][16][17] Thus, the purpose of this report was to reexamine our experience with open thoracic and TAAA repair to determine the potential impact of the changes on mortality and morbidity.…”

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confidence: 99%

A Quarter Century of Organ Protection in Open Thoracoabdominal Repair

et al. 2015

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“…Settepani et al 1showed a 5% mortality rate in a systematic literature review covering the last ten years. Nevertheless, data from the National Impatient Sample (9,10) and the Medicare Provider Analysis and Review (11,12) reflect very different results, with worldwide mortality rates ranging from 15% to 20%.…”

Section: Current Resultsmentioning

confidence: 99%

Debranching aortic surgery

et al. 2017

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Conventional open surgery still remains as the gold standard of care for aortic arch and thoracoabdominal pathology. In centers of excellence, open repair of the arch has been performed with 5% immediate mortality and a low rate of complications; however overall mortality rates are around 15%, being up to 40% of all patients rejected for treatment due to their age or comorbidities. For thoracoabdominal aortic pathology, data reported from centers of excellence show immediate mortality rates from 5% to 19%, spinal cord ischemia from 2.7% to 13.2%, and renal failure needing dialysis from 4.6% to 5.6%. For these reasons, different alternatives that use endovascular techniques, including debranching procedures, have been developed. The reported results for hybrid debranching procedures are controversial and difficult to interpret because series are retrospective, heterogenic and including a small number of patients. Clearly, an important selection bias exists: debranching procedures are performed in elderly patients with more comorbidities and with thoracoabdominal aortic aneurysms that have more complex and extensive disease. Considering this fact, debranching procedures still remain a useful alternative: for aortic arch pathology debranching techniques can avoid or reduce the time of extracorporeal circulation (ECC) or cardiac arrest which may be beneficial in high-risk patients that otherwise would be rejected for treatment. And compared to pure endovascular techniques, they can be used in emergency cases with applicability in a wide range of anatomies. For thoracoabdominal aortic aneurysms, they are mainly useful when other lesser invasive endovascular options are not feasible due to anatomical limitations or when they are not available in cases where delaying the intervention is not an option.

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Impact of hospital volume and type on outcomes of open and endovascular repair of descending thoracic aneurysms in the United States Medicare population

Cited by 54 publications

References 24 publications

Treatment at low‐volume hospitals is associated with reduced short‐term and long‐term outcomes for patients with retroperitoneal sarcoma

Treatment at low‐volume hospitals is associated with reduced short‐term and long‐term outcomes for patients with retroperitoneal sarcoma

A Quarter Century of Organ Protection in Open Thoracoabdominal Repair

Debranching aortic surgery

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