Key result
High-volume centers and surgeons are linked to reduced perioperative mortality in complex aortic aneurysm repairs.
Why the study?
Several studies suggested that surgical procedures at high-volume centers may result in superior outcomes, especially for technically demanding aortic aneurysm repairs, but comprehensive evaluation was needed.
Does treatment at high-volume centers or by high-volume surgeons reduce perioperative mortality in patients undergoing aortic aneurysm repair?
Does treatment at high-volume centers or by high-volume surgeons reduce perioperative mortality in patients undergoing aortic aneurysm repair?
High-volume centers and surgeons are associated with lower perioperative mortality in complex aortic aneurysm repairs, highlighting the importance of regionalization for these procedures.
High-volume centers associated with better aortic aneurysm repair outcomes; leaves open whether volume thresholds should guide referrals without prospective data.
Several studies have suggested that surgical procedures performed at high-volume centers may result in superior outcome. Technically more demanding procedures such as aortic aneurysm repair appear to demonstrate a stronger relationship with volume. The present chapter reviewed the literature using the MEDLINE database to identify studies investigating the effect of volume in aortic aneurysm repair outcomes. The great majority of studies identified shows an advantage for high-volume hospitals with regard to perioperative mortality of abdominal (AAA), thoracic (TAA) and thoracoabdominal (TAAA) aortic aneurysm repair. A similar advantage is shown for high-volume surgeons. The volume advantage appears to be less evident for simple endovascular procedures (EVAR & TEVAR), compared to more complex endovascular (F/BEVAR) and open surgical procedures. Superior outcomes observed in high-volume hospitals are not only explained by increased surgeons' experience, but importantly also by a more effective management of intra- and postoperative complications. Confounding factors to be taken into account are the timing of the studies in relation to positive evolution of outcomes in several high-risk procedures, and patient cohorts selected in regions with very low- and very high-volume hospitals only.
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Katsargyris et al. (2017) conducted a review in Aortic aneurysm. High-volume hospitals and surgeons vs. Low-volume hospitals and surgeons was evaluated on Perioperative mortality. High-volume hospitals and surgeons were associated with reduced perioperative mortality for complex aortic aneurysm repairs compared to lower-volume centers.
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