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The Relationship Between Operative Volume and Peri-operative Mortality After Non-elective Aortic Aneurysm Repair in Australia.
- Source :
-
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2020 Oct; Vol. 60 (4), pp. 519-530. Date of Electronic Publication: 2020 Jul 02. - Publication Year :
- 2020
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Abstract
- Objective: Hospital and surgeon operative caseload is thought to be associated with peri-operative mortality following the non-elective repair of aortic aneurysms; however, whether such an association exists within the Australian healthcare setting is unknown.<br />Methods: The Australasian Vascular Audit was interrogated to identify patients undergoing non-elective (emergency [EMG] or semi-urgent [URG]) aortic aneurysm repair between 2010 and 2016, as well as their treating surgeon and hospital. Hierarchal logistic regression modelling was used to assess the impact of caseload on outcomes after both endovascular (EVAR) and open surgical repair (OSR).<br />Results: Volume counts were determined from 14 262 patients (4 121 OSR and 10 141 EVAR). After exclusion of elective procedures and duplicates, 1 153 EVAR (570 EMG and 583 URG) and 1 245 OSR (946 EMG and 299 URG) non-elective cases remained for the analysis. Crude mortality was 24.0% following OSR (EMG 29.2%; URG 7.7%) and 7.5% following EVAR (EMG 12.6%; URG 2.4%). Univariable analysis demonstrated an association between OSR mortality and hospital volume (quintile [Q] 1: 25.3%, Q2: 27.8%, Q3: 23.9%, Q4: 27.0%, Q5: 16.2%; p = .030), but not surgeon (Q1: 25.2%, Q2: 27.4%, Q3: 26.0%, Q4: 21.4%, Q5: 19.5%, p = .32). Multivariable analysis confirmed this association (odds ratio (OR) [95% CI]; Q1 vs 5: 1.91 [1.13-3.21], Q2 vs. 5: 2.01[1.24-3.25], Q3 vs. 5: 1.41 [0.86-2.29], Q4 vs. 5: 1.92 [1.17-3.15]; p = .020). The difference was most pronounced in the EMG OSR group [Q1 - 3 vs. 4-5] (OR 1.63 [1.07-2.48]; p = .020). Mortality after EVAR was not associated with either hospital (Q1: 6.3%, Q2: 10%, Q3: 6.8%, Q4: 4.5%, Q5: 10%; p = .14) or surgeon volume (Q1: 9.3%, Q2: 5.7%, Q3: 8.1%, Q4: 7.0%, Q5: 7.3%; p = .67).<br />Conclusion: There is an inverse correlation between hospital volume and peri-operative mortality following EMG open repair of aortic aneurysm. These data support restructuring Australian pathways of care to direct suspected ruptured aneurysm to institutions that reach a minimum volume threshold.<br /> (Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal diagnostic imaging
Aortic Aneurysm, Abdominal mortality
Aortic Rupture diagnostic imaging
Aortic Rupture mortality
Australia epidemiology
Clinical Competence
Databases, Factual
Emergencies
Female
Hospital Mortality
Humans
Male
Medical Audit
Middle Aged
Postoperative Complications mortality
Postoperative Complications therapy
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Aortic Aneurysm, Abdominal surgery
Aortic Rupture surgery
Endovascular Procedures adverse effects
Endovascular Procedures mortality
Hospitals, High-Volume
Hospitals, Low-Volume
Outcome and Process Assessment, Health Care
Surgeons
Vascular Surgical Procedures adverse effects
Vascular Surgical Procedures mortality
Workload
Subjects
Details
- Language :
- English
- ISSN :
- 1532-2165
- Volume :
- 60
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 32624387
- Full Text :
- https://doi.org/10.1016/j.ejvs.2020.04.029