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Effect of Endovascular Aneurysm Repair on the Volume-Outcome Relationship in Aneurysm Repair

Holt, PJ; Poloniecki, JD; Khalid, U; Hinchliffe, RJ; Loftus, IM; Thompson, MM (2009) Effect of Endovascular Aneurysm Repair on the Volume-Outcome Relationship in Aneurysm Repair. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES, 2 (6). 624 - 632 (9). ISSN 1941-7713 https://doi.org/10.1161/CIRCOUTCOMES.109.848465
SGUL Authors: Hinchliffe, Robert James Holt, Peter James Edward Poloniecki, Jan Dominik Thompson, Matthew Merfyn Loftus, Ian

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Abstract

Background— We aim to quantify the relationship between the annual caseload (volume) and outcome from elective endovascular (EVR) or open repair of abdominal aortic aneurysms (AAAs) in England between 2005 and 2007. Methods and Results— Individual patient data were obtained from the Hospital Episode Statistics. Statistical methods included multiple logistic regression models, mortality control charts, and safety plots to determine the nature of any relationship between volume and outcome. The case-mix between hospitals of different sizes was examined using observed and expected values for in-hospital mortality. Outcome measures included in-hospital mortality and hospital length of stay. Between 2005 and 2007, a total of 57 587 patients were admitted to hospitals in England with a diagnosis of AAA, and 11 574 underwent AAA repair. There were 7313 elective AAA repairs, of which 5668 (78%) were open and 1645 (22%) were EVR. In-hospital mortality rates were 5.63% for all elective AAA repairs with rates of 6.18% for open repair and 3.77% for EVR (odds ratio, 0.676; 95% CI, 0.501 to 0.913; P=0.011). High-volume aneurysm services were associated with significantly lower mortality rates overall (0.991; 0.988 to 0.994; P<0.0001), for open repairs (0.994; 0.991 to 0.998; P=0.0008), and EVR (0.989; 0.982 to 0.995; P=0.0007). Large endovascular units had low mortality rates for open repairs. Conclusion— A strong relationship existed between the volume of surgery performed and outcome from both open and endovascular aneurysm repairs. These data support the concept that abdominal aortic surgery should be performed in specialized units that meet a minimum volume threshold.

Item Type: Article
Additional Information: PubMed ID: 20031901
Keywords: Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal, Aortic Rupture, Diagnosis-Related Groups, England, Female, Hospital Mortality, Hospitals, Humans, Length of Stay, Logistic Models, Male, Outcome Assessment (Health Care), Quality of Health Care, Risk Factors, Surgical Procedures, Elective, Vascular Surgical Procedures, Science & Technology, Life Sciences & Biomedicine, Cardiac & Cardiovascular Systems, Cardiovascular System & Cardiology, aneurysm, mortality, surgery, assessment, outcomes, quality of health care, RANDOMIZED CONTROLLED-TRIAL, HOSPITAL VOLUME, UNITED-STATES, MORTALITY, METAANALYSIS, SURGERY, MASS, Aged, Aged,80 and over, Aortic Aneurysm, Aortic Aneurysm,Abdominal, Aortic Rupture, diagnosis, Diagnosis-Related Groups, England, epidemiology, Female, Hospital Mortality, Hospitals, Humans, Length of Stay, Logistic Models, Male, methods, mortality, Outcome Assessment (Health Care), Quality of Health Care, Risk Factors, statistics & numerical data, surgery, Surgical Procedures,Elective, Vascular Surgical Procedures, aneurysm, mortality, surgery, assessment, outcomes, quality of health care
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Cardiac (INCCCA)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Vascular & Cardiac Surgery (INCCVC)
Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES
ISSN: 1941-7713
Related URLs:
Dates:
DateEvent
1 November 2009Published
Web of Science ID: WOS:000276078500016
URI: http://openaccess.sgul.ac.uk/id/eprint/104109
Publisher's version: https://doi.org/10.1161/CIRCOUTCOMES.109.848465

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