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Volume versus outcome when treating abdominal aortic aneurysm electively: is there evidence to centralise?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
2008 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, Vol. 97, no 2, 154-159 p.Article, review/survey (Refereed) Published
Abstract [en]

AIM: To identify evidence for the minimum annual case load of open repairs of abdominal aortic aneurysms compatible with an acceptable perioperative mortality rate. METHOD: A PubMed search resulted in 137 references, sixteen articles with original data on volume and mortality not older than ten years were identified and selected for review. RESULT: Three studies found no volume-mortality relationship when controlled for age, sex and medical risk. Six studies verified volume thresholds of 20 procedures per year or more. In seven studies hospital volumes of 7-17 elective abdominal aortic aneurysm (AAA) repairs per year were sufficient to reach a mortality rate of a national average or similar to that of higher volume centres. No studies were published on the minimum annual case-load of EndoVascular Aneurysm Repair (EVAR), or of a combination of EVAR and open repair. CONCLUSION: Recent studies in North America and in Europe indicate that 10-15 procedures annually can be sufficient to safely perform open AAA repairs. Centres regularly performing less should consider referral. Continuous monitoring and audit of risk-adjusted perioperative mortality rates should be practiced in all centres.

Place, publisher, year, edition, pages
2008. Vol. 97, no 2, 154-159 p.
Keyword [en]
Abdominal aortic aneurysm, Perioperative mortality, Threshold values for outcome, Volume-mortality in aneurysm repairs, Volume-mortality relationship, Volume-outcome relationship
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-87814ISI: 000256057700017PubMedID: 18575035OAI: oai:DiVA.org:uu-87814DiVA: diva2:133722
Available from: 2009-01-14 Created: 2009-01-14 Last updated: 2011-01-13Bibliographically approved

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