Association between operation volume and postoperative mortality in the elective open repair of infrarenal abdominal aor
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onellenfitsch1,2 · K. Meisenbacher2 · M. Ante2 · M. Grilli3 · D. Böckler2,4 1
Universitätsklinik und Poliklinik für Viszerale, Gefäß- und Endokrine Chirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany 2 Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Germany 3 4
Fachinformation Medizin und Gesundheitsberufe, Karlsruhe, Germany Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
Association between operation volume and postoperative mortality in the elective open repair of infrarenal abdominal aortic aneurysms: systematic review
Background and aim Current 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]. Repair can be done as an open (OR) or an endovascular (EVAR) approach. The overall number of elective AAA operations in Germany in 2017 was 67,741, with 27,102 (40.0%) as OR and 40,639 (60.0%) as EVAR [3]. Depending on data sources and denominator (in-hospital vs. 60-day mortality), perioperative mortality is estimated at 3.9–5.1% for OR and 0.9–2.8% for EVAR [3, 4]. While in the early years after OR and EVAR had been established most operations were done in high-volume institutions with regard to the specific intervention, relating to both the individual department and the individual surgeon, The German version of this article can be found under https://doi.org/10.1007/s00772020-00671-y
this has changed over time with increasing adoption of the techniques into clinical routine. Nowadays, OR and EVAR are also carried out in institutions with low operation-specific case volumes. According to the AAA register of the German Institute for Vascular Health Research (DIGG) of the Germany Society of Vascular Surgery (DGG), 60% of hospitals offering OR perform less than five operations annually. Likewise, 20% of hospitals offering EVAR have a volume of less than 20 elective cases per year [4]. Even though large centers with a high volume are probably underrepresented in the register, which thus 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. For numerous operations, there is evidence showing an inverse association between case numbers, related to both the hospital and individual surgeon and perioperative mortality [5, 6]. In some healthcare systems this has led to the definition of a minimum volume per hospital and surgeon for certain volumecritical interventions, below which these can no longer be performed or are not
reimbursed by the healthcare system [7]. Elective infrarenal AAA repair has been evaluated in numerous studies regarding a possible association between case volume and postoperative outcomes. This systematic review aims at synthesizing all available data on the association between ca
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