Association between operation volume and postoperative mortality in elective endovascular repair of infrarenal abdominal aortic aneurysms: systematic review—continuation

Background Many surgical interventions show an inverse association between case volume per hospital/surgeon and perioperative mortality. In the first part of this systematic review it was shown that such an association also exists for the open treatment of infrarenal aortic aneurysms. The second part now examines a possible association with endovascular treatment of infrarenal aortic aneurysms. Objective In a systematic review, the data available on the association between the case volume per hospital/surgeon and perioperative mortality in elective endovascular treatment of infrarenal aortic aneurysms are presented. Materials and Methods Systematic research using defined keywords was carried out. All original works comparing elective endovascular treatment of an infrarenal aortic aneurysm in a “high volume” center with a “low volume” center or by a “high volume” surgeon with a “low volume” surgeon, as defined in each study, were included. Results After deduplication, the literature search produced 1,021 hits. Of these, 16 publications fulfilled the inclusion criteria. With regard to the thresholds for the definition of high volume and low volume, there was marked heterogeneity between individual studies. Twelve of the 15 studies showed a significantly lower mortality in high volume than in low volume centers. The effect measures, usually odds ratios, were between 0.43 and 0.91. In the comparison between high volume and low volume surgeons, there was no difference in mortality in any of the five studies included. Discussion The available data on the association between case volume per hospital and surgeon and the perioperative mortality in elective endovascular treatment of infrarenal aortic aneurysms consistently show that patients operated on in high volume centers have a lower mortality. The volume per surgeon seems to have no influence on perioperative mortality. To achieve the lowest perioperative mortality possible in endovascular treatment of infrarenal aortic aneurysms, centralization with high volume per hospital should be aimed for, taking into consideration the context of the health care system.