The Relationship Between Operative Volume and Peri-operative Mortality After Non-elective Aortic Aneurysm Repair in Australia.

Szczegóły
Abstrakt

Tytuł:: The Relationship Between Operative Volume and Peri-operative Mortality After Non-elective Aortic Aneurysm Repair in Australia.
Autorzy:: Sawang M; Department of Surgery, Prince of Wales Hospital, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia.
Paravastu SCV; Department of Surgery, Prince of Wales Hospital, Sydney, Australia; Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, UK.
Liu Z; Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia.
Thomas SD; Department of Surgery, Prince of Wales Hospital, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia; The Vascular Institute, Prince of Wales Hospital, Sydney, Australia.
Beiles CB; Australasian Vascular Audit, Australian and New Zealand Society for Vascular Surgery, Melbourne, Australia.
Mwipatayi BP; University of Western Australia, School of Surgery and Royal Perth Hospital, Department of Vascular Surgery, Perth, Australia.
Verhagen HJM; Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands.
Verhoeven ELG; Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany.
Varcoe RL; Department of Surgery, Prince of Wales Hospital, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia; The Vascular Institute, Prince of Wales Hospital, Sydney, Australia. Electronic address: .
Źródło:: 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.
Typ publikacji:: Comparative Study; Journal Article
Język:: English
Imprint Name(s):: Publication: 2002-: London : Elsevier
Original Publication: London, UK : W.B. Saunders Co. Ltd., c1995-
MeSH Terms:: 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*
Aortic Aneurysm, Abdominal/*surgery
Aortic Rupture/*surgery
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
Contributed Indexing:: Keywords: Aortic aneurysm; Aortic rupture; Clinical competence; Healthcare; Outcome assessment (healthcare); Quality indicators; Vascular surgical procedures
Entry Date(s):: Date Created: 20200707 Date Completed: 20201013 Latest Revision: 20201013
Update Code:: 20240105
DOI:: 10.1016/j.ejvs.2020.04.029
PMID:: 32624387
: Czasopismo naukowe

Full Text Finder

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.
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).
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).
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.
(Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Informacja