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Optimal Threshold f...
Optimal Threshold for the Volume-Outcome Relationship After Open AAA Repair in the Endovascular Era : Analysis of the International Consortium of Vascular Registries
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- Scali, Salvatore T. (author)
- Univ Florida, Coll Med, Div Vasc Surg & Endovasc Therapy, Gainesville, FL USA.
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- Beck, Adam (author)
- Univ Alabama Birmingham, Div Vasc Surg & Endovasc Therapy, Birmingham, AL USA.
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- Sedrakyan, Art (author)
- Weill Cornell Med Coll, Populat Hlth Sci, New York, NY USA.
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- Mao, Jialin (author)
- Weill Cornell Med Coll, Populat Hlth Sci, New York, NY USA.
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- Behrendt, Christian-Alexander (author)
- Univ Med Ctr Hamburg Eppendorf, Dept Vasc Med, Working Grp GermanVasc, Hamburg, Germany.
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- Boyle, Jonathan R. (author)
- Cambridge Univ Hosp NHS Trust, Addenbrookes Hosp, Cambridge Vasc Unit, Cambridge, England.
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- Venermo, Maarit (author)
- Univ Helsinki, Dept Vasc Surg, Helsinki, Finland.;Helsinki Univ Hosp, Helsinki, Finland.
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- Faizer, Rumi (author)
- Univ Minnesota, Div Vasc Surg, Minneapolis, MN USA.
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- Schermerhorn, Marc (author)
- Beth Israel Deaconess Med Ctr, Div Vasc & Endovasc Surg, Boston, MA 02215 USA.
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- Beiles, Barry (author)
- Australasian Soc Vasc Surg, Australasian Vasc Audit, Melbourne, Vic, Australia.
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- Szeberin, Zoltan (author)
- Semmelweis Univ, Dept Vasc Surg, Budapest, Hungary.
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- Eldrup, Nikolaj (author)
- Univ Copenhagen, Rigshosp, Dept Vasc Surg, Copenhagen, Denmark.
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- Thomson, Ian (author)
- Univ Otago, Dept Surg, Dunedin, New Zealand.
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- Cassar, Kevin (author)
- Univ Malta, Fac Med & Surg, Dept Surg, Msida, Malta.
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- Altreuther, Martin (author)
- St Olavs Hosp, Dept Vasc Surg, Trondheim, Norway.
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- Debus, Sebastian (author)
- Univ Med Ctr Hamburg Eppendorf, Dept Vasc Med, Working Grp GermanVasc, Hamburg, Germany.
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- Johal, Amundeep (author)
- Royal Coll Surgeons England, Clin Effectiveness Unit, London, England.
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- Björck, Martin (author)
- Uppsala universitet,Kärlkirurgi
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- Cronenwett, Jack L. (author)
- Dartmouth Hitchcock Med Ctr, Sect Vasc Surg, Lebanon, NH 03766 USA.
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- Mani, Kevin, 1975- (author)
- Uppsala universitet,Kärlkirurgi
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Univ Florida, Coll Med, Div Vasc Surg & Endovasc Therapy, Gainesville, FL USA Univ Alabama Birmingham, Div Vasc Surg & Endovasc Therapy, Birmingham, AL USA. (creator_code:org_t)
- Elsevier, 2021
- 2021
- English.
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In: European Journal of Vascular and Endovascular Surgery. - : Elsevier. - 1078-5884 .- 1532-2165. ; 61:5, s. 747-755
- Related links:
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http://www.ejves.com...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Objective: As open abdominal aortic aneurysm (AAA) repair (OAR) rates decline in the endovascular era, the endorsement of minimum volume thresholds for OAR is increasingly controversial, as this may affect credentialing and training. The purpose of this analysis was to identify an optimal centre volume threshold that is associated with the most significant mortality reduction after OAR, and to determine how this reflects contemporary practice.Methods: This was an observational study of OARs performed in 11 countries (2010 - 2016) within the International Consortium of Vascular Registry database (n = 178 302). The primary endpoint was post-operative in hospital mortality. Two different methodologies (area under the receiving operating curve optimisation and Markov chain Monte Carlo procedure) were used to determine the optimal centre volume threshold associated with the most significant mortality improvement.Results: In total, 154 912 (86.9%) intact and 23 390 (13.1%) ruptured AAAs were analysed. The majority (63.1%; n = 112 557) underwent endovascular repair (EVAR) (OAR 36.9%; n = 65 745). A significant inverse relationship between increasing centre volume and lower peri-operative mortality after intact and ruptured OAR was evident (p < .001) but not with EVAR. An annual centre volume of between 13 and 16 procedures per year was associated with the most significant mortality reduction after intact OAR (adjusted predicted mortality < 13 procedures/year 4.6% [95% confidence interval 4.0% - 5.2%] vs. = 13 procedures/year 3.1% [95% CI 2.8% - 3.5%]). With the increasing adoption of EVAR, the mean number of OARs per centre (intact + ruptured) decreased significantly (2010 - 2013 = 35.7; 2014 - 2016 = 29.8; p < .001). Only 23% of centres (n = 240/1 065) met the >= 13 procedures/year volume threshold, with significant variation between nations (Germany 11%; Denmark 100%).Conclusion: An annual centre volume of 13 - 16 OARs per year is the optimal threshold associated with the greatest mortality risk reduction after treatment of intact AAA. However, in the current endovascular era, achieving this threshold requires significant re-organisation of OAR practice delivery in many countries, and would affect provision of non-elective aortic services. Low volume centres continuing to offer OAR should aim to achieve mortality results equivalent to the high volume institution benchmark, using validated data from quality registries to track outcomes.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Keyword
- Open AAA repair
- Threshold
- Volume-Outcome
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Scali, Salvatore ...
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Beck, Adam
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Sedrakyan, Art
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Mao, Jialin
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Behrendt, Christ ...
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Boyle, Jonathan ...
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show more...
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Venermo, Maarit
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Faizer, Rumi
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Schermerhorn, Ma ...
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Beiles, Barry
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Szeberin, Zoltan
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Eldrup, Nikolaj
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Thomson, Ian
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Cassar, Kevin
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Altreuther, Mart ...
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Debus, Sebastian
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Johal, Amundeep
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Björck, Martin
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Cronenwett, Jack ...
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Mani, Kevin, 197 ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
- Articles in the publication
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European Journal ...
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Uppsala University