Key result
Higher hospital AAA repair volumes linked to lower mortality for open but not endovascular repair.
Why the study?
Recent evidence was needed to investigate and update volume-outcome relationships after open surgical repair and endovascular repair of abdominal aortic aneurysm in England.
Does higher annual hospital volume improve in-hospital mortality in patients undergoing open or endovascular repair of abdominal aortic aneurysm?
Observational (n=72,022)
Yes
Does higher annual hospital volume improve in-hospital mortality in patients undergoing open or endovascular repair of abdominal aortic aneurysm?
Higher annual hospital volume of AAA repairs is associated with significantly lower in-hospital mortality for open surgical repair, but not for endovascular repair.
Answers are grounded in this paper and cite their sources.
May support selective referral for open AAA repair to higher-volume centers; leaves open volume standards for EVAR.
BACKGROUND: The aim of this study was to use recent evidence to investigate and update volume-outcome relationships after open surgical repair (OSR) and endovascular repair (EVAR) of abdominal aortic aneurysm in England. METHODS: Hospital Episode Statistics (HES) data from April 2006 to March 2018 were obtained. The primary outcome was in-hospital death. Other outcomes included duration of hospital stay, readmissions within 30 days, and critical care requirements. Case-mix adjustment included age, sex, HES year, deprivation index, weekend admission, mode of admission, type of procedure and co-morbidities. RESULTS: Annual volume of all repairs combined appeared to be an appropriate measure of volume. After case-mix adjustment, a significant relationship between volume and in-hospital mortality was seen for OSR (P < 0·001) but not for EVAR (P = 0·169 for emergency and P = 0·363 for elective). The effect appeared to extend beyond 60 repairs per year to volumes above 100 repairs per year. There was no significant relationship between volume and duration of hospital stay or 30-day readmissions. In patients receiving emergency OSR, higher volume was associated with longer stay in critical care. CONCLUSION: Higher annual all-procedure volumes were associated with significantly lower in-hospital mortality for OSR, but such a relationship was not significant for EVAR. There was not enough evidence for a volume effect on other outcomes.
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Tong et al. (2021) conducted an observational in Abdominal aortic aneurysm (n=72,022). Higher annual hospital volume vs. Lower annual hospital volume was evaluated on In-hospital mortality (elective open surgical repair) (OR 0.996, 95% CI 0.995-0.998, p=<0.001). Higher annual hospital volumes of abdominal aortic aneurysm repairs were associated with significantly lower in-hospital mortality for open surgical repair, but not for endovascular repair.
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