Key result
Open AAA repair at lower-volume centers achieves low ~1.5% 30-day mortality with experienced teams.
Why the study?
Centralisation of open abdominal aortic aneurysm repair is widely advocated, but supporting evidence often conflates institutional volume with individual surgeon expertise.
Cohort (n=195)
No
Favourable outcomes for open AAA repair can be achieved at small- to medium-volume centres when performed by experienced surgeons within a structured multidisciplinary team, challenging the strict volume-based centralization paradigm.
May support open AAA repair at lower-volume centers; leaves open whether volume thresholds warrant revision without prospective data.
Background/Objectives: Centralisation of open abdominal aortic aneurysm (AAA) repair is widely advocated, but supporting evidence often conflates institutional volume with individual surgeon expertise. We report outcomes of open AAA repair at a small- to medium-volume centre and assess the contributions of surgeon experience, multidisciplinary perioperative care, and supervised surgical teaching. Methods: Retrospective analysis of all consecutive patients undergoing open AAA repair between January 2017 and December 2023. Endovascular procedures were excluded. The primary endpoint was 30-day all-cause mortality. Secondary endpoints included perioperative morbidity, acute kidney injury (AKI), length of stay, and overall survival. Results: A total of 195 patients underwent open AAA repair (162 elective; 33 urgent/emergency), with a mean of 27.9 cases annually. Mean age was 70.2 years (SD 8.1), and 85.6% were male. Thirty-day mortality was 1.5% overall (3/195) and 1.2% (2/162) for elective cases, with no significant difference between elective and urgent/emergency cases (1.2% vs. 3.0%; p = 0.430). No perioperative strokes occurred; myocardial infarction occurred in three patients (1.5%). Median operative time was 261 min (IQR 210–320), reflecting systematic supervised teaching in approximately 95% of cases. AKI occurred in 10.3%; clinically significant renal insufficiency at 30 days occurred in 5.1%, and no patient required permanent renal replacement therapy. The perioperative reintervention rate was 9.2%, and median hospital stay was 8 days (IQR 7–12). At a mean follow-up of 62.3 months (SD 25.1), overall mortality was 7.7% and aneurysm-related mortality 1.0%. Kaplan–Meier estimated overall survival was 98.5%, 95.8%, and 89.0% at 1, 3, and 7 years, respectively. Conclusions: Favourable outcomes can be achieved at small- to medium-volume centres through concentrated surgeon expertise, structured teaching, and a high-functioning multidisciplinary team. These findings support a more nuanced assessment of open AAA repair that considers surgeon experience, team performance, and demonstrated outcomes rather than institutional volume alone.
No takes yet. Share an insight, caveat, or question.
Robaldo et al. (2026) conducted a cohort in Abdominal aortic aneurysm (n=195). Open abdominal aortic aneurysm repair was evaluated on 30-day all-cause mortality. Open abdominal aortic aneurysm repair at a small-to-medium volume centre achieved a 30-day all-cause mortality of 1.5% overall, demonstrating favourable outcomes independent of high institutional volume.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: