Key result
Hospital volumes of 10-15 elective open abdominal aortic aneurysm repairs annually appear sufficient to achieve acceptable perioperative mortality rates.
Why the study?
Does higher annual hospital case volume reduce perioperative mortality in patients undergoing elective open repair of abdominal aortic aneurysms?
Does higher annual hospital case volume reduce perioperative mortality in patients undergoing elective open repair of abdominal aortic aneurysms?
A minimum annual hospital volume of 10-15 elective open AAA repairs appears sufficient to achieve acceptable perioperative mortality rates, suggesting centers performing fewer should consider referral.
Centers with <10-15 annual elective open AAA repairs should consider referral; extends volume-outcome evidence by defining a practical minimum threshold.
AIM: To identify evidence for the minimum annual case load of open repairs of abdominal aortic aneurysms compatible with an acceptable perioperative mortality rate. METHOD: A PubMed search resulted in 137 references, sixteen articles with original data on volume and mortality not older than ten years were identified and selected for review. RESULT: Three studies found no volume-mortality relationship when controlled for age, sex and medical risk. Six studies verified volume thresholds of 20 procedures per year or more. In seven studies hospital volumes of 7-17 elective abdominal aortic aneurysm (AAA) repairs per year were sufficient to reach a mortality rate of a national average or similar to that of higher volume centres. No studies were published on the minimum annual case-load of EndoVascular Aneurysm Repair (EVAR), or of a combination of EVAR and open repair. CONCLUSION: Recent studies in North America and in Europe indicate that 10-15 procedures annually can be sufficient to safely perform open AAA repairs. Centres regularly performing less should consider referral. Continuous monitoring and audit of risk-adjusted perioperative mortality rates should be practiced in all centres.
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Thomas Troëng (2008) conducted a review in Abdominal aortic aneurysm (n=16). Hospital volume of elective open AAA repairs vs. Lower volume centers was evaluated on Perioperative mortality rate. Hospital volumes of 10-15 elective open abdominal aortic aneurysm repairs annually appear sufficient to achieve acceptable perioperative mortality rates.
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