Provider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures.

Hdl Handle:
http://hdl.handle.net/10147/209286
Title:
Provider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures.
Authors:
Killeen, Shane D; Andrews, Emmet J; Redmond, Henry P; Fulton, Gregory J
Affiliation:
Department of Academic Surgery, National University of Ireland (NUI)/University, College Cork (UCC), Cork University Hospital, Cork, Ireland., sdfkilleen@eircom.net
Citation:
J Vasc Surg. 2007 Mar;45(3):615-26.
Journal:
Journal of vascular surgery : official publication, the Society for Vascular, Surgery [and] International Society for Cardiovascular Surgery, North American, Chapter
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/209286
DOI:
10.1016/j.jvs.2006.11.019
PubMed ID:
17321352
Abstract:
BACKGROUND: Intuitively, vascular procedures performed by high-volume vascular subspecialists working at high-volume institutions should be associated with improved patient outcome. Although a large number of studies assess the relationship between volume and outcome, a single contemporary compilation of such studies is lacking. METHODS: A review of the English language literature was performed incorporating searches of the Medline, EMBASE, and Cochrane collaboration databases for abdominal aortic aneurysm repair (elective and emergent), carotid endarterectomy, and arterial lower limb procedures for any volume outcome relationship. Studies were included if they involved a patient cohort from 1980 onwards, were community or population based, and assessed health outcomes (mortality and morbidity) as a dependent variable and volume as an independent variable. RESULTS: We identified 74 relevant studies, and 54 were included. All showed either an inverse relationship of variable magnitude between provider volume and mortality, or no volume-outcome effect. The reduction in the risk-adjusted mortality rate (RAMR) for high-volume providers was 3% to 11% for elective abdominal aortic aneurysm (AAA) repair, 2.5 to 5% for emergent AAA repair, 0.7% to 4.7% carotid endarterectomy, and 0.3% to 0.9% for lower limb arterial bypass procedures. Subspeciality training also conferred a considerable morbidity and mortality benefit for emergent AAA repair, carotid endarterectomy, and lower limb arterial procedures. CONCLUSION: High-volume providers have significantly better outcomes for vascular procedures both in the elective and emergent setting. Subspeciality training also has a considerable impact. These data provide further evidence for the specialization of vascular services, whereby vascular procedures should generally be preformed by high-volume, speciality trained providers.
Language:
eng
MeSH:
Aortic Aneurysm, Abdominal/mortality/*surgery; Carotid Artery Diseases/mortality/*surgery; Certification; Education, Medical, Graduate; Emergency Medical Services/statistics & numerical data; Endarterectomy, Carotid/statistics & numerical data; Health Facility Size; Hospital Mortality/trends; Hospitals/*statistics & numerical data; Humans; Lower Extremity/blood supply; Peripheral Vascular Diseases/mortality/*surgery; Risk Assessment; Specialties, Surgical/education/*statistics & numerical data; Surgical Procedures, Elective/statistics & numerical data; Survival Analysis; Treatment Outcome; Vascular Surgical Procedures/education/*statistics & numerical data; Workload/*statistics & numerical data
ISSN:
0741-5214 (Print); 0741-5214 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorKilleen, Shane Den_GB
dc.contributor.authorAndrews, Emmet Jen_GB
dc.contributor.authorRedmond, Henry Pen_GB
dc.contributor.authorFulton, Gregory Jen_GB
dc.date.accessioned2012-02-03T15:17:13Z-
dc.date.available2012-02-03T15:17:13Z-
dc.date.issued2012-02-03T15:17:13Z-
dc.identifier.citationJ Vasc Surg. 2007 Mar;45(3):615-26.en_GB
dc.identifier.issn0741-5214 (Print)en_GB
dc.identifier.issn0741-5214 (Linking)en_GB
dc.identifier.pmid17321352en_GB
dc.identifier.doi10.1016/j.jvs.2006.11.019en_GB
dc.identifier.urihttp://hdl.handle.net/10147/209286-
dc.description.abstractBACKGROUND: Intuitively, vascular procedures performed by high-volume vascular subspecialists working at high-volume institutions should be associated with improved patient outcome. Although a large number of studies assess the relationship between volume and outcome, a single contemporary compilation of such studies is lacking. METHODS: A review of the English language literature was performed incorporating searches of the Medline, EMBASE, and Cochrane collaboration databases for abdominal aortic aneurysm repair (elective and emergent), carotid endarterectomy, and arterial lower limb procedures for any volume outcome relationship. Studies were included if they involved a patient cohort from 1980 onwards, were community or population based, and assessed health outcomes (mortality and morbidity) as a dependent variable and volume as an independent variable. RESULTS: We identified 74 relevant studies, and 54 were included. All showed either an inverse relationship of variable magnitude between provider volume and mortality, or no volume-outcome effect. The reduction in the risk-adjusted mortality rate (RAMR) for high-volume providers was 3% to 11% for elective abdominal aortic aneurysm (AAA) repair, 2.5 to 5% for emergent AAA repair, 0.7% to 4.7% carotid endarterectomy, and 0.3% to 0.9% for lower limb arterial bypass procedures. Subspeciality training also conferred a considerable morbidity and mortality benefit for emergent AAA repair, carotid endarterectomy, and lower limb arterial procedures. CONCLUSION: High-volume providers have significantly better outcomes for vascular procedures both in the elective and emergent setting. Subspeciality training also has a considerable impact. These data provide further evidence for the specialization of vascular services, whereby vascular procedures should generally be preformed by high-volume, speciality trained providers.en_GB
dc.language.isoengen_GB
dc.subject.meshAortic Aneurysm, Abdominal/mortality/*surgeryen_GB
dc.subject.meshCarotid Artery Diseases/mortality/*surgeryen_GB
dc.subject.meshCertificationen_GB
dc.subject.meshEducation, Medical, Graduateen_GB
dc.subject.meshEmergency Medical Services/statistics & numerical dataen_GB
dc.subject.meshEndarterectomy, Carotid/statistics & numerical dataen_GB
dc.subject.meshHealth Facility Sizeen_GB
dc.subject.meshHospital Mortality/trendsen_GB
dc.subject.meshHospitals/*statistics & numerical dataen_GB
dc.subject.meshHumansen_GB
dc.subject.meshLower Extremity/blood supplyen_GB
dc.subject.meshPeripheral Vascular Diseases/mortality/*surgeryen_GB
dc.subject.meshRisk Assessmenten_GB
dc.subject.meshSpecialties, Surgical/education/*statistics & numerical dataen_GB
dc.subject.meshSurgical Procedures, Elective/statistics & numerical dataen_GB
dc.subject.meshSurvival Analysisen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.subject.meshVascular Surgical Procedures/education/*statistics & numerical dataen_GB
dc.subject.meshWorkload/*statistics & numerical dataen_GB
dc.titleProvider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures.en_GB
dc.contributor.departmentDepartment of Academic Surgery, National University of Ireland (NUI)/University, College Cork (UCC), Cork University Hospital, Cork, Ireland., sdfkilleen@eircom.neten_GB
dc.identifier.journalJournal of vascular surgery : official publication, the Society for Vascular, Surgery [and] International Society for Cardiovascular Surgery, North American, Chapteren_GB
dc.description.provinceMunster-

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