Provider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures.
AffiliationDepartment of Academic Surgery, National University of Ireland (NUI)/University, College Cork (UCC), Cork University Hospital, Cork, Ireland., firstname.lastname@example.org
MeSHAortic Aneurysm, Abdominal/mortality/*surgery
Carotid Artery Diseases/mortality/*surgery
Education, Medical, Graduate
Emergency Medical Services/statistics & numerical data
Endarterectomy, Carotid/statistics & numerical data
Health Facility Size
Hospitals/*statistics & numerical data
Lower Extremity/blood supply
Peripheral Vascular Diseases/mortality/*surgery
Specialties, Surgical/education/*statistics & numerical data
Surgical Procedures, Elective/statistics & numerical data
Vascular Surgical Procedures/education/*statistics & numerical data
Workload/*statistics & numerical data
MetadataShow full item record
CitationJ Vasc Surg. 2007 Mar;45(3):615-26.
JournalJournal of vascular surgery : official publication, the Society for Vascular, Surgery [and] International Society for Cardiovascular Surgery, North American, Chapter
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.
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