A new study in the March 2011 issue of the Journal of Vascular Surgery®, the official publication of the Society for Vascular Surgery®, has revealed that for open repair of intact elective abdominal aortic aneurysms (AAAs), surgeon annual volume rather than institutional volume is more strongly associated with decreased in-hospital mortality. Previous studies have primarily centered on institutional volume rather than individual surgeon volume; therefore researchers wanted to statistically determine the relative effects of both in-hospital mortality after open and endovascular aneurysm repairs (EVAR) for AAAs.
Co-author Andres Schanzer, MD, a surgeon from the division of vascular and endovascular surgery at the University of Massachusetts Medical School in Worcester, MA, said the Nationwide Inpatient Sample (2003-2007) was used to identify all patients who underwent open repair (5,972) or EVAR (1,821) for non-ruptured AAAs in 11 participating states that record a unique physician identifier for each procedure were reviewed. Complete details of this study have been published in the March issue of the Journal of Vascular Surgery®.
Surgeon and institution volume were defined as low (first quintile), medium (second, third, or fourth quintile), and high (fifth quintile). Stratification by institution volume and then by surgeon volume was performed to analyze in-hospital mortality. Multivariable models were used to evaluate the association of institution and surgeon volume with mortality for open repair and EVAR, controlling for potential confounders.
Dr. Schanzer said that for open AAA repair, a significant mortality reduction was associated with both annual institution volume (low less than 7, medium 7-30, and high less than 30) and surgeon volume (low less than 2, medium 3-9, and high more than 9). He added that high surgeon volume conferred a greater mortality reduction than did high institution volume.