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May 1, 2021British journal of surgeryOpen Access

Volume–outcome relationships in open and endovascular repair of abdominal aortic aneurysm: administrative data 2006–2018

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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?

Population

Patients undergoing OSR or EVAR of abdominal aortic aneurysm in England

Comparison

Hospital procedure volume

Design

Retrospective administrative database study

Key result

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.

Authors

TTThaison TongAAAhmed AberJCJ. Chilcott

Discussion

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Member takes

Overview

May support selective referral for open AAA repair to higher-volume centers; leaves open volume standards for EVAR.

Study Design

Type

Observational (n=72,022)

Multicenter

Yes

Structured PICO

Does higher annual hospital volume improve in-hospital mortality in patients undergoing open or endovascular repair of abdominal aortic aneurysm?

P
Population
72,022 patients who underwent open surgical repair (OSR) or endovascular repair (EVAR) of abdominal aortic aneurysm (AAA) in England between April 2006 and March 2018.
I
Intervention
Higher annual hospital volume of AAA repairs (all procedures combined)
C
Comparator
Lower annual hospital volume of AAA repairs
O
Outcome
In-hospital death (defined by whether the patient was discharged alive or dead at the end of the index admission)hard clinical

Main Result

Effect estimate: OR 0.996 (95% CI 0.995-0.998)

p-value: p=<0.001

Higher annual hospital volume of AAA repairs is associated with significantly lower in-hospital mortality for open surgical repair, but not for endovascular repair.

Limitations

  • Administrative data lacks anatomical information and specific patient selection factors for case-mix adjustment.
  • Does not account for patients turned down for emergency procedures.
  • Only examined short-term in-hospital outcomes, lacking long-term follow-up data.
  • HES data do not include anatomical information
  • Aspects of patient selection are not available for case-mix adjustment
  • Higher-volume centres may be selecting patients with more complex anatomy for EVAR
  • Emergency data do not take account of selection that may take place in turning down patients for emergency procedures

Cite This Study

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.

synapsesocial.com/papers/6a17877b5fdf2a7b88aa1e58https://doi.org/10.1002/bjs.11919
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