yz8rtmc4

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?:abstract	OBJECTIVES Operative volume has been used as a marker of quality. Research from past decades has suggested minimum open abdominal aortic aneurysm repair (OAAA) volume requirements for surgeons (9-13 OAAA/year) and hospitals (18 OAAA/year) to purportedly achieve acceptable results. Given concerns regarding the decreased frequency of open repairs in the endovascular era, we examined the association of surgeon and hospital volume with 30- and 90-day mortality in the Vascular Quality Initiative (VQI) registry. METHODS Patients who underwent elective OAAA repair between 2013-2018 were identified in the VQI registry. We cross-sectionally evaluated the association of average hospital and surgeon volume with 30-day postoperative mortality using a hierarchical Bayesian model. Cross-level interaction was permitted and random surgeon- and hospital-level intercepts were used to account for clustering. Mortality results were adjusted by standardizing to the observed distribution of relevant covariates in the overall cohort. Outcomes were compared to the Society for Vascular Surgery (SVS) guidelines recommended criteria of <5% perioperative mortality. RESULTS 3,078 patients underwent elective OAAA repair by 520 surgeons at 128 hospitals. The 30- and 90-day risks of postoperative mortality were 4.1% (n=126) and 5.4% (n=166), respectively. Mean surgeon volume and hospital volume were both inversely correlated with 30-day mortality. Averaged across all patients and hospitals, there was a 96% probability that surgeons who performed an average of ≥4 repairs per year achieved <5% 30-day mortality. There was substantial interplay between surgeon volume and hospital volume. For example, at lower volume hospitals performing an average of 5 repairs per year, <5% 30-day mortality would be expected 69% of the time for surgeons performing an average of 3 operations per year. Conversely, at higher volume hospitals performing an average of 40 repairs per year, a <5% 30-day mortality would be expected 96% of the time by surgeons performing an average 3 operations annually. As hospital volume increased, there was diminishing difference in 30-day mortality between lower and higher volume surgeons. Likewise, as surgeon volume increased, there was diminishing difference in 30-day mortality between lower and higher volume hospitals. CONCLUSIONS Surgeons and hospitals in the VQI registry achieved mortality outcomes below 5% (SVS guidelines) with an average surgeon volume that was substantially lower compared with previous reports. Further, when considering minimal surgeon volume guidelines, it is important to contextualize outcomes within hospital volumes.
is ?:annotates of	<https://research.tib.eu/covid-19/entity/yz8rtmc4_hasAnnotation_C4284302>
?:creator	<https://research.tib.eu/covid-19/entity/Sharma%2C_Gaurav%3B_Madenci%2C_Arin_L%3B_Wanis%2C_Kerollos_Nashat%3B_Comment%2C_Leah_A%3B_Lotto%2C_Christine_E%3B_Shah%2C_Samir_K%3B_Ozaki%2C_C_Keith%3B_Subramanian%2C_S_V%3B_Eldrup-Jorgensen%2C_Jens%3B_Belkin%2C_Michael>
?:doi	10.1016/j.jvs.2020.07.108
?:doi	<https://research.tib.eu/covid-19/entity/10.1016/j.jvs.2020.07.108>
?:journal	Journal_of_vascular_surgery
?:license	unk
?:pmid	<https://research.tib.eu/covid-19/entity/32976969.0>
?:pmid	32976969.0
?:publication_isRelatedTo_Disease	<https://research.tib.eu/covid-19/entity/COVID-19>
?:source	Medline
?:title	Association and Interplay of Surgeon and Hospital Volume with Mortality Following Open Abdominal Aortic Aneurysm Repair in the Modern Era.
?:type	<https://research.tib.eu/covid-19/vocab/Publication>
?:year	2020-09-22

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?:abstract

OBJECTIVES Operative volume has been used as a marker of quality. Research from past decades has suggested minimum open abdominal aortic aneurysm repair (OAAA) volume requirements for surgeons (9-13 OAAA/year) and hospitals (18 OAAA/year) to purportedly achieve acceptable results. Given concerns regarding the decreased frequency of open repairs in the endovascular era, we examined the association of surgeon and hospital volume with 30- and 90-day mortality in the Vascular Quality Initiative (VQI) registry. METHODS Patients who underwent elective OAAA repair between 2013-2018 were identified in the VQI registry. We cross-sectionally evaluated the association of average hospital and surgeon volume with 30-day postoperative mortality using a hierarchical Bayesian model. Cross-level interaction was permitted and random surgeon- and hospital-level intercepts were used to account for clustering. Mortality results were adjusted by standardizing to the observed distribution of relevant covariates in the overall cohort. Outcomes were compared to the Society for Vascular Surgery (SVS) guidelines recommended criteria of <5% perioperative mortality. RESULTS 3,078 patients underwent elective OAAA repair by 520 surgeons at 128 hospitals. The 30- and 90-day risks of postoperative mortality were 4.1% (n=126) and 5.4% (n=166), respectively. Mean surgeon volume and hospital volume were both inversely correlated with 30-day mortality. Averaged across all patients and hospitals, there was a 96% probability that surgeons who performed an average of ≥4 repairs per year achieved <5% 30-day mortality. There was substantial interplay between surgeon volume and hospital volume. For example, at lower volume hospitals performing an average of 5 repairs per year, <5% 30-day mortality would be expected 69% of the time for surgeons performing an average of 3 operations per year. Conversely, at higher volume hospitals performing an average of 40 repairs per year, a <5% 30-day mortality would be expected 96% of the time by surgeons performing an average 3 operations annually. As hospital volume increased, there was diminishing difference in 30-day mortality between lower and higher volume surgeons. Likewise, as surgeon volume increased, there was diminishing difference in 30-day mortality between lower and higher volume hospitals. CONCLUSIONS Surgeons and hospitals in the VQI registry achieved mortality outcomes below 5% (SVS guidelines) with an average surgeon volume that was substantially lower compared with previous reports. Further, when considering minimal surgeon volume guidelines, it is important to contextualize outcomes within hospital volumes.

is ?:annotates of