The Relationship Between Aortic Aneurysm Surgery Volume and Peri-Operative Mortality in Australia

Sawang, Michael; Paravastu, Sharath; Liu, Zhixin; Thomas, Shannon D.; Beiles, Barry; Mwipatayi, Bibombe P.; Verhagen, Hence J.M.; Verhoeven, Eric L.G.; Varcoe, Ramon L.

doi:10.1016/j.ejvs.2018.09.019

Cited by 27 publications

(22 citation statements)

References 46 publications

(37 reference statements)

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“…Despite the Australian Vascular Audit being compulsory, evidence suggests that it only contains 63% of procedures, and therefore outcomes may be prone to selection bias. 8,33 Furthermore, the retrospective nature of the analysis performed in this study cannot account for all the potential differences in patient selection between countries and this makes comparisons difficult. Some confounders within the analysis have been adjusted for, but this adjustment was bound by the available data and adjustment for co-morbidity was limited to diabetes, cardiac disease, and renal impairment.…”

Section: Discussionmentioning

confidence: 99%

“…Case ascertainment rates have been reported previously at > 90% of aortic procedures performed in Denmark, Hungary, Malta, New Zealand, Sweden, and the UK, 80% in Norway and 63% in Australia. 2,8 The Finnish registry collects complete data from the Helsinki region, but not the whole of Finland. The Vascular Quality Initiative (VQI) collects data from over 700 units in North America capturing about 23% of AAA repairs in the United States and the German Registry has over 130 participating centres.…”

Section: Registry Informationmentioning

confidence: 99%

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Editor's Choice – Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010 – 2016

Boyle

Mao

Beck

et al. 2021

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSIn this study of over 100 000 intact abdominal aortic aneurysm repairs, an increase in the proportion of patients undergoing endovascular aneurysm repair (EVAR) over time has been demonstrated. Peri-operative mortality rates are falling for both EVAR and open surgical repair. Outcomes however are poorer in women and octogenarians, and future efforts should be focused on improving outcomes for these patients.Objective: Outcomes for intact abdominal aortic aneurysm (AAA) repair vary over time and by healthcare system, country, and surgeon. The aim of this study was to analyse peri-operative mortality for intact AAA repair in 11 countries over time and compare outcomes by gender, age, and geographical location. Methods: Prospective data on primary repair of intact AAA were collected from 11 countries through the International Consortium of Vascular Registries (ICVR) and analysed for two time periods, 2010 e 2013 and 2014 e 2016. The primary outcome was peri-operative mortality after endovascular aneurysm repair (EVAR) and open surgical repair (OSR). Multivariable logistic regression models were used to adjust for differences in patient characteristics. Results: A total of 103 715 patients were included. The percentage of patients undergoing EVAR increased from 63.6% to 71.2% (p < .001) over the study period. This proportion varied by country from 35% in Hungary to 81% in the United States. Overall peri-operative mortality decreased from 2.1% to 1.6 % (p < .001). Mortality also declined significantly over time for both OSR 4.2% to 3.6 % (p ¼ .002) and EVAR 1.0% to 0.7% (p ¼ .002). Mortality was significantly higher for female than male patients (3.0% vs. 1.6% p < .001). The percentage of patients > 80 years old undergoing AAA repair remained constant at 23.6% (p ¼ .91). Peri-operative mortality was higher for patients > 80 years than for those < 80 years old (2.7% vs. 1.6% p < .001). Fortysix per cent (n ¼ 275) of all EVAR deaths occurred in the over 80s. Conclusion:The proportion of AAA repairs performed using EVAR has increased over time. Peri-operative mortality continues to decline for both OSR and EVAR. Outcomes however were significantly worse for both women and those aged over 80, so efforts should be focused on these patient groups to further reduce elective AAA mortality rates.

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Section: Discussionmentioning

confidence: 99%

Section: Registry Informationmentioning

confidence: 99%

Editor's Choice – Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010 – 2016

Boyle

Mao

Beck

et al. 2021

European Journal of Vascular and Endovascular Surgery

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“…There was an inverse correlation between both surgeon volume of open aortic aneurysm repair, hospital volume of thoracic EVAR and in hospital mortality. These findings suggest that in Australia TEVAR should be performed by high volume hospitals and OSR by high volume surgeons [220]. Esce et al analysed 11,086 intact AAA repair s between 2000 and 2008 using the New York Statewide Planning and Research Cooperative System inpatient database and determined 6 cases per year as the threshold to achieve the improved mortality of a high volume center [221].…”

Section: Large Trials Meta-analyses Databases and Registries On Outcomesmentioning

confidence: 99%

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

Nikol

Mathias²,

Olinic

et al. 2020

Vasa

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“…This registry based study from Australia investigated the impact of hospital and surgeon volume on the outcome of abdominal aortic aneurysm repair over a seven year period. 1 In keeping with contemporary data the authors were unable to identify any volume effect for endovascular aneurysm repair (EVAR), 2 and somewhat more surprisingly no volume effect for open repair at surgeon or hospital level. The EVAR group included both complex EVAR cases and thoracic endovascular aneurysm repairs (TEVARs), both of which had expected higher mortalities, of 2.6% and 5.6%, respectively.…”

mentioning

confidence: 90%

Is In Hospital Mortality Following EVAR Still a Valid Outcome Measure?

Boyle

2019

European Journal of Vascular and Endovascular Surgery

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The Relationship Between Aortic Aneurysm Surgery Volume and Peri-Operative Mortality in Australia

Cited by 27 publications

References 46 publications

Editor's Choice – Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010 – 2016

Editor's Choice – Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010 – 2016

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

Is In Hospital Mortality Following EVAR Still a Valid Outcome Measure?

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