Treatment of abdominal aortic aneurysm in an entire state over 7 years

Hospital volume, calendar age, and short term outcomes in patients undergoing repair of abdominal aortic aneurysms: the Ontario experience, 1988-92.

“…Pilcher et al have suggested that resuscitation and selective transfer, as well as emergency operations in selected smaller hospitals, might be effective policies in the management of ruptured aneurysms. 8 Although the overall CFR in our study sample was low, the rate in ruptured aneurysms remained 10 times higher than that in unruptured aneurysms. This emphasises the need for more effective detection of aneurysms with elective repair of the dilated aorta.…”

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

“…All six studies included in the metaanalysis found a statistically significant reduction in mortality with increased surgeon operating volumes. [25][26][27][28]35,37 No significant statistical heterogeneity was demonstrated for the meta-analysis (Q-stat5, 6.56; 5 df; I 2 ϭ 23.7%).…”

“…24 After exclusions, 14 articles provided information on the annual surgeon volume of elective AAA repair and mortality. [25][26][27][28][29][30][31][32][33][34][35][36][37][38] A total of 115,273 elective AAA repairs (range, 207-39,794 cases) were considered. The mean mortality rate was 5.56%, and the observed mortality rate decreased as a surgeon's annual operative volume increased (Fig 2; Table).…”

Surgeon case volume, not institution case volume, is the primary determinant of in-hospital mortality after elective open abdominal aortic aneurysm repair

“…A recent meta-analysis by Young et al, 11 including 6 studies (n ϭ 51,453) that focused on surgeon volume and AAA mortality rates, [12][13][14][15][16][17] demonstrated that AAA repair by a high-volume surgeon was protective (OR, 0.56; 95% CI, 0.54-0.57; P Ͻ .0001). 11 However, in this meta-analysis, it is not possible to assess the relative effect of surgeon and hospital volumes because hospital volume was not homogeneously controlled for in each of the included studies.…”

“…A recent meta-analysis did demonstrate an association between high surgeon volume and improved mortality for elective open AAA repair; 11 however, no adjustment was made in the metaanalysis to assess whether institution volume played a role in driving this relationship. [12][13][14][15][16][17] Other studies have failed to demonstrate an association between surgeon volume and mortality outcomes after AAA repair. 18,19 The purpose of this study was to analyze the relative effects of both hospital and surgeon elective annual volume on outcomes after both endovascular and open repair of intact AAAs.…”