Key result
Highest volume centers had significantly lower odds of failure to rescue after EVAR (OR 0.54; 95% CI 0.34-0.87) and OAR (OR 0.22; 95% CI 0.11-0.44) compared to lowest volume centers.
Why the study?
Failure to rescue reflects the inability to effectively manage complications and prevent death, but the association between hospital volume and failure to rescue after open or endovascular repair of intact abdominal aortic aneurysms remained to be investigated.
Does treatment at high-volume centers reduce failure to rescue in patients undergoing intact AAA repair?
Observational (n=60,273)
Yes
Does treatment at high-volume centers reduce failure to rescue in patients undergoing intact AAA repair?
Odds Ratio: 0.54 (95% CI 0.34–0.87)
p-value: p=0.04
Higher hospital volume is significantly associated with lower odds of failure to rescue (in-hospital death following major complications) after both open and endovascular repair of intact abdominal aortic aneurysms.
Higher hospital volume was associated with lower FtR after AAA repair; leaves open whether volume-based referral improves rescue rates.
OBJECTIVE: To investigate the association between hospital volume and failure to rescue (FtR), after open repair (OAR), and endovascular repair (EVAR) of intact abdominal aortic aneurysms (AAA) among centers participating in the VASCUNET and International Consortium of Vascular Registries. SUMMARY OF BACKGROUND DATA: FtR (ie, in-hospital death following major complications) is a composite end-point representing the inability to treat complications effectively and prevent death. METHODS: Using data from 8 vascular registries, complication and mortality rates after intact AAA repair were examined (n = 60,273; EVAR-43,668; OAR-16,605). A restricted analysis using pooled data from 4 countries (Australia, Hungary, New Zealand, and USA) reporting data on all postoperative complications (bleeding, stroke, cardiac, respiratory, renal, colonic ischemia) was performed to identify risk-adjusted association between hospital volume and FtR. RESULTS: The most frequently reported complications were cardiac (EVAR-3.0%, OAR-8.9%) and respiratory (EVAR-1.0%, OAR-5.7%). In adjusted analysis, 4.3% of EVARs and 18.5% of OARs had at least 1 complication. The overall FtR rate was 10.3% after EVAR and 15.7% after OAR. Subjects treated in the highest volume centers (Q4) had 46% and 80% lower odds of FtR after EVAR (OR = 0.54; 95% CI = 0.34-0.87; P = 0.04) and OAR (OR = 0.22; 95% CI = 0.11-0.44; P < 0.001) when compared to lowest volume centers (Q1), respectively. Colonic ischemia had the highest risk of FtR for both procedures (adjusted predicted risks, EVAR: 27%, 95% CI 14%-45%; OAR: 30%, 95% CI 17%-46%). CONCLUSIONS: In this multi-national dataset, FtR rate after intact AAA repair with EVAR and OAR is significantly associated with hospital volume. Hospitals in the top volume quartiles achieve the lowest mortality after a complication has occurred.
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D’Oria et al. (2021) conducted an observational in Intact abdominal aortic aneurysms (AAA) (n=60,273). Highest hospital volume (Q4) vs. Lowest hospital volume (Q1) was evaluated on Failure to rescue (in-hospital death following major complications) (OR 0.54, 95% CI 0.34-0.87, p=0.04). Highest volume centers had significantly lower odds of failure to rescue after EVAR (OR 0.54; 95% CI 0.34-0.87) and OAR (OR 0.22; 95% CI 0.11-0.44) compared to lowest volume centers.
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