Increasing surgeon volume correlates with patient survival following open abdominal aortic aneurysm repair
| Autor: | Jennifer L. Ellis, Antoinette Esce, Ankit Medhekar, Kathleen Raman, Fergal J. Fleming, Michael C. Stoner, Roan J. Glocker, Adam J. Doyle |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Databases Factual New York Workload 030204 cardiovascular system & hematology Risk Assessment 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans Statistical analysis 030212 general & internal medicine Surgeon volume Aged Quality Indicators Health Care Retrospective Studies Surgeons Case volume Practice patterns business.industry General surgery Patient survival Perioperative medicine.disease Abdominal aortic aneurysm Outcome and Process Assessment Health Care Treatment Outcome Open repair Female Surgery Clinical Competence Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures Aortic Aneurysm Abdominal |
| Zdroj: | Journal of Vascular Surgery. 70:762-767 |
| ISSN: | 0741-5214 |
| DOI: | 10.1016/j.jvs.2018.11.027 |
| Popis: | Objective The annual number of open abdominal aortic aneurysm (AAA) repairs has decreased dramatically over the last decade, making the search for physician case volume thresholds more important. The purpose of this study was to identify a minimum threshold for annual surgeon case volume in open AAA repair. Methods The New York Statewide Planning and Research Cooperative System inpatient database was used to identify all patients undergoing open repair of an intact AAA between 2000 and 2008. Thirty-day survival was calculated using New York State vital records, which contain all New York State death certificates. The annual case volume for each surgeon was defined as the number of open AAA repairs performed in the year of the index procedure. The Contal and O'Quigley method was used to identify a minimum volume threshold. Results A total of 11,086 patients were included in the analysis. The selected cutpoint was six or more cases per year based on maximization of the Contal and O'Quigley test statistic. The high-volume group had comparable rates of cardiovascular comorbidities, but significantly improved 30-day and 5-year survival rates as well as shorter lengths of stay in the hospital. Conclusions This study identifies an ideal threshold for minimum annual surgeon case volume for open AAA repair. Over the study period, perioperative mortality would not have occurred in up to 150 patients if all procedures had been done by high-volume surgeons performing at least six repairs per year. However, even a minimum annual threshold of at least two repairs per year provided a mortality benefit. Ideal minimum volume thresholds should be developed using rigorous statistical analysis as well as local information about practice patterns. |
| Databáze: | OpenAIRE |
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