Abstract
AbstractBackgroundAn inverse association between the case volume per hospital and surgeon and perioperative mortality has been shown for many surgical interventions. There are numerous studies on this issue for the open treatment of infrarenal aortic aneurysms.AimTo present the available data on the association between the case volume per hospital and surgeon and perioperative mortality in the elective open repair of infrarenal aortic aneurysms in a systematic review.Materials and methodsUsing the PubMed, Cochrane Library, Web of Science Core Collection, CINAHL, Current Contents Medicine (CCMed), and ClinicalTrials.gov databases, a systematic search was performed using defined keywords. From the search results, all original papers were included that compared the elective open repair 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 the respective study.ResultsAfter deduplication, the literature search yielded 1021 hits of which 60 publications met the inclusion criteria. Of these, 37/43 studies showed a lower mortality in “high volume” compared to “low volume” centers and 14/17 comparisons showed a lower mortality for “high volume” compared to “low volume” surgeons. The effect measures, usually odds ratios, ranged from 0.37 to 0.99 for volume per hospital and 0.31 to 0.92 for volume per surgeon. Regarding the threshold values for the definition of “high volume” and “low volume,” a clear heterogeneity was shown between the individual studies.DiscussionThe available data on the association between the case volume per hospital and surgeon and perioperative mortality in the elective open repair of infrarenal aortic aneurysms show that interventions performed in “high volume” centers or by “high volume” surgeons are associated with lower mortality. To ensure the best possible outcome in terms of low perioperative mortality in the open repair of infrarenal aortic aneurysms, the aim should be centralization with high case volume per hospital and surgeon.
Highlights
Background and aimCurrent national and international guidelines recommend elective repair of infrarenal abdominal aortic aneurysms (AAA) for prevention of rupture and embolism depending on the maximum transverse diameter of the aneurysm and on the physical status and comorbidities of the patient [1, 2]
Even though large centers with a high volume are probably underrepresented in the register, which overestimates the proportion of hospitals with a low annual case volume, it becomes apparent that a relevant number of German hospitals have a low volume for OR of infrarenal AAA
The threshold used for defining low volume
Summary
Background and aimCurrent national and international guidelines recommend elective repair of infrarenal abdominal aortic aneurysms (AAA) for prevention of rupture and embolism depending on the maximum transverse diameter of the aneurysm and on the physical status and comorbidities of the patient [1, 2]. There is evidence showing an inverse association between case numbers, related to both the hospital and individual surgeon and perioperative mortality [5, 6]. Elective infrarenal AAA repair has been evaluated in numerous studies regarding a possible association between case volume and postoperative outcomes. Aim. To present the available data on the association between the case volume per hospital and surgeon and perioperative mortality in the elective open repair of infrarenal aortic aneurysms in a systematic review. All original papers were included that compared the elective open repair 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 the respective study. Regarding the threshold values for the definition of “high volume” and “low volume,” a clear heterogeneity was shown between the individual studies
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