Meta-analysis and systematic review of the relationship between surgeon annual caseload and mortality for elective open abdominal aortic aneurysm repairs

Young, Emily; Holt, Peter; Poloniecki, Jan; Loftus, Ian; Thompson, Matt

doi:10.1016/j.jvs.2007.06.038

Cited by 87 publications

(59 citation statements)

References 43 publications

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“…The association between higher annual procedure volume and improved patient outcomes has been demonstrated for several sophistical medical interventions such as major surgical procedures or (minimally invasive) cardiovascular interventions [35-37]. Likewise, TIPS placement for treating sequalae of PH requires a high degree of technical and clinical expertise to limit complications and achieve optimal patient outcomes [38-40].…”

Section: Discussionmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist’s Experience

Buechter¹,

Manka²,

Gerken³

et al. 2018

Dig Dis

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Background and Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice in decompensated portal hypertension. TIPS revision due to thrombosis or stenosis increases morbidity and mortality. Our aim was to investigate patient- and procedure-associated risk factors for TIPS-revision. Patients and Methods: We retrospectively evaluated 189 patients who underwent the TIPS procedure. Only patients who required TIPS revision within 1 year (Group I, 34 patients) and patients who did not require re-intervention within the first year (Group II [control group], 54 patients) were included. Results: Out of 88 patients, the majority were male (69.3%) and mean age was 56 ± 11 years. Indications for TIPS were refractory ascites (68%), bleeding (24%), and Budd-Chiari syndrome (8%). The most frequent liver disease was alcohol-induced cirrhosis (60%). Forty-three patients (49%) received bare and 45 patients (51%) covered stents, thus resulting in reduction of hepatic venous pressure gradient (HVPG) from 19.0 to 9.0 mm Hg. When comparing patient- and procedure-related factors, the type of stent (p < 0.01) and interventionalist’s experience (number of performed TIPS implantations per year; p < 0.05) were the only factors affecting the risk of re-intervention due to stent dysfunction, while age, gender, indication, Child-Pugh, and model of end-stage liver disease score, platelet count, pre- and post-HVPG, additional variceal embolization, stent diameter, and number of stents did not significantly differ. Conclusion: Patients undergoing TIPS procedure should be surveilled closely for shunt dysfunction while covered stents and high-level experience are associated with increased patency.

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Section: Discussionmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist’s Experience

Buechter¹,

Manka²,

Gerken³

et al. 2018

Dig Dis

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“…The management is dependent on aortic morphology and the patient's overall fitness 2 . Elective AAA repair carries a mortality risk of 3-8 per cent 3,4 . In contrast, emergency surgery is associated with at least a 50 per cent mortality rate, although this may fall with the limited introduction of emergency endovascular aneurysm repair in specialist centres 2,5 .…”

Section: Introductionmentioning

confidence: 99%

Reproducibility of ultrasound measurement of the abdominal aorta

Beales

Wolstenhulme

Evans

et al. 2011

British Journal of Surgery

123

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“…As patient volume increases, an institution generally improves its outcomes. This has been shown in many medical disciplines such as cardiovascular surgery (Young et al 2007), orthopedic surgery (Shervin et al 2007) and neonatal intensive care (Phibbs et al 2007). Unlike many areas of medicine, resuscitation often…”

Section: Introductionmentioning

confidence: 99%

Initiation of a pediatric mock code program at a children's hospital

et al. 2009

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Background: Pediatric cardiopulmonary arrests are rare. Mock codes were instituted to bridge the gap between opportunity and reality. Aim: The goal was to improve medical caregivers' skills in pediatric resuscitation. Methods: All pediatric and internal medicine/pediatric (med/peds) residents were anonymously surveyed pre-and postintervention about confidence level about codes and code skills. Twenty mock codes were conducted during the 1 year intervention period. Statistical comparisons were made between each resident pre-and post-survey, graduating third-year residents (PGY3s) prior to intervention versus PGY3s with mock codes and pediatric versus med/peds residents. Results: All residents significantly improved in their perception of overall skill level during the study ( p < 0.0001). PGY3s were significantly more confident in their skills than PGY2s or PGY1s and PGY2s were significantly more confident than PGY1s both pre-and post-mock codes ( p < 0.0001). Med/peds residents were significantly more confident in their skills than pediatric residents both pre-( p ¼ 0.041) and post-intervention ( p ¼ 0.016). The two skills with the lowest score post-intervention were the ability to place an interosseous line and the ability to manage cardiac dysrhythmias. Conclusions: Pediatric mock codes can improve resident confidence and self-assessment of their resuscitation skills. Data from surveys such as this can be used to design future skill-based educational initiatives.

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Meta-analysis and systematic review of the relationship between surgeon annual caseload and mortality for elective open abdominal aortic aneurysm repairs

Abstract: As surgeons performed higher annual volumes of elective open AAA repairs, significantly lower mortality rates were demonstrated. Surgeons wishing to perform elective AAA repairs should achieve a minimum case volume of 13 repairs per annum.

Cited by 87 publications

References 43 publications

Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist’s Experience

Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist’s Experience

Reproducibility of ultrasound measurement of the abdominal aorta

Initiation of a pediatric mock code program at a children's hospital

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