Abstract
Objective: We evaluate nationwide perioperative outcomes of complex EVAR and assess the volume-outcome association of complex EVAR. Summary of Background Data: Endovascular treatment with fenestrated (FEVAR) or branched (BEVAR) endografts is progressively used for excluding complex aortic aneurysms (complex AAs). It is unclear if a volumeoutcome association exists in endovascular treatment of complex AAs (complex EVAR). Methods: All patients prospectively registered in the Dutch Surgical Aneurysm Audit who underwent complex EVAR (FEVAR or BEVAR) between January 2016 and January 2020 were included. The effect of annual hospital volume on perioperative mortality was examined using multivariable logistic regression analyses. Patients were stratified into quartiles based on annual hospital volume to determine hospital volume categories. Results: We included 694 patients (539 FEVAR patients, 155 BEVAR patients). Perioperative mortality following FEVAR was 4.5% and 5.2% following BEVAR. Postoperative complication rates were 30.1% and 48.7%, respectively. The first quartile hospitals performed <9 procedures/ yr; second, third, and fourth quartile hospitals performed 9-12, 13-22, and 23 procedures/yr. The highest volume hospitals treated significantly more complex patients. Perioperative mortality of complex EVAR was 9.1% in hospitals with a volume of <9, and 2.5% in hospitals with a volume of 13 (P = 0.008). After adjustment for confounders, an annual volume of 13 was associated with less perioperative mortality compared to hospitals with a volume of <9. Conclusions: Data from this nationwide mandatory quality registry shows a significant effect of hospital volume on perioperative mortality following complex EVAR, with high volume complex EVAR centers demonstrating lower mortality rates.
| Original language | English |
|---|---|
| Pages (from-to) | E678-E688 |
| Journal | Annals of surgery |
| Volume | 277 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 1 Mar 2023 |
Keywords
- complex AAA
- endovascular
- mortality
- volume-outcome
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In: Annals of surgery, Vol. 277, No. 3, 01.03.2023, p. E678-E688.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Association of Hospital Volume with Perioperative Mortality of Endovascular Repair of Complex Aortic Aneurysms
T2 - A Nationwide Cohort Study
AU - Alberga, Anna J.
AU - von Meijenfeldt, Gerdine C. I.
AU - Rastogi, Vinamr
AU - de Bruin, Jorg L.
AU - Wever, Jan J.
AU - van Herwaarden, Joost A.
AU - Hamming, Jaap F.
AU - Hazenberg, Constantijn E. V. B.
AU - van Schaik, Jan
AU - Mees, Barend M. E.
AU - van der Laan, Maarten J.
AU - Zeebregts, Clark J.
AU - Schurink, Geert W. H.
AU - Verhagen, Hence J. M.
AU - van den Akker, P. J.
AU - Akkersdijk, G. P.
AU - Akkersdijk, W. L.
AU - van Andringa de Kempenaer, M. G.
AU - Arts, C. H. P.
AU - Avontuur, A. M.
AU - Bakker, O. J.
AU - Balm, R.
AU - Barendregt, W. B.
AU - Bekken, J. A.
AU - Bender, M. H. M.
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AU - Blankensteijn, J. D.
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AU - Bodegom, M. E.
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AU - Borger van der Burg, B. L. S.
AU - de Borst, G. J.
AU - Bos-van Rossum, W. T. G. J.
AU - Bosma, J.
AU - Botman, J. M. J.
AU - Bouwman, L. H.
AU - Brehm, V.
AU - de Bruijn, M. T.
AU - de Bruin, J. L.
AU - Brummel, P.
AU - van Brussel, J. P.
AU - Buijk, S. E.
AU - Buimer, M. G.
AU - Buscher, H. C. J. L.
AU - Cancrinus, E.
AU - Castenmiller, P. H.
AU - Cazander, G.
AU - Cuypers, P. W. M.
AU - Daemen, J. H. C.
AU - Dawson, I.
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AU - Dinkelman, M. K.
AU - Dirven, M.
AU - Dolmans, D. E. J. G. J.
AU - van Dortmont, L. M. C.
AU - Drouven, J. W.
AU - van der Eb, M. M.
AU - Eefting, D.
AU - van Eijck, G. J. W. M.
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AU - Elsman, A. H. P.
AU - van der Elst, A.
AU - van Engeland, M. I. A.
AU - van Eps, G. S.
AU - Faber, M. J.
AU - de Fijter, W. M.
AU - Fioole, B.
AU - Fritschy, W. M.
AU - Fung Kon Jin, P. H. P.
AU - Geelkerken, R. H.
AU - van Gent, W. B.
AU - Glade, G. J.
AU - Govaert, B.
AU - Groenendijk, R. P. R.
AU - de Groot, H. G. W.
AU - van den Haak, R. F. F.
AU - de Haan, E. F. A.
AU - Hajer, G. F.
AU - Hamming, J. F.
AU - van Hattum, E. S.
AU - Hazenberg, C. E. V. B.
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AU - Huisman, L. C.
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AU - Jansbeken, J. R. H.
AU - Janssen, R. J. L.
AU - Jiang, H. H. L.
AU - de Jong, S. C.
AU - Jongbloed-Winkel, T. A.
AU - Jongkind, V.
AU - Kapma, M. R.
AU - Keller, B. P. J. A.
AU - Jahrome, A. Khodadade
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AU - van Lammeren, G. W.
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AU - Manshanden, C. G.
AU - Mat-Tens, E. C. J. L.
AU - Meerwaldt, R.
AU - Mees, B. M. E.
AU - Menting, T. P.
AU - Metz, R.
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AU - Molegraaf, M. J.
AU - Montauban van Swijn-Dregt, Y. C. A.
AU - Morak, M. J. M.
AU - van de Mortel, R. H. W.
AU - Mulder, W.
AU - Nagesser, S. K.
AU - Naves, C. C. L. M.
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AU - Nevenzel, A. M.
AU - de Nie, A. J.
AU - Nieuwenhuis, D. H.
AU - van Nieuwenhuizen, R. C.
AU - Nieuwenhui-Zen, J.
AU - Nio, D.
AU - Oomen, A. P. A.
AU - Oranen, B. I.
AU - Oskam, J.
AU - Palamba, H. W.
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AU - van Petersen, A. S.
AU - Petri, B. J.
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AU - Rouwet, E. V.
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AU - van't Sant, H. P.
AU - van Schaik, J.
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AU - Scheltinga, M. R. M.
AU - Schepers, A.
AU - Schlejen, P. M.
AU - Schlösser, F. J. V.
AU - Schol, F. P. G.
AU - Scholtes, V. P. W.
AU - Schouten, O.
AU - Schreve, M. A.
AU - Schurink, G. W. H.
AU - Sikkink, C. J. J. M.
AU - te Slaa, A.
AU - Smeets, H. J.
AU - Smeets, L.
AU - Smeets, R. R.
AU - de Smet, A. A. E. A.
AU - Smit, P. C.
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AU - Snoeijs, M. G. J.
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AU - Stokmans, R. A.
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AU - The, R. M.
AU - Thijsse, W. J.
AU - Thomassen, I.
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AU - Türkcan, K.
AU - Nolthenius, R. P. Tutein
AU - Ünlü, C.
AU - Vaes, R. H. D.
AU - Vahl, A. C.
AU - Veen, E. J.
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AU - Veldman, M. G.
AU - Verhagen, H. J. M.
AU - Verhoeven, B. A. N.
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AU - Vermeulen, E. G. J.
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AU - van der Vijver-Coppen, R. J.
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AU - van der Vliet, J. A.
AU - van Vlijmen-van Keulen, C. J.
AU - van der Vorst, J. R.
AU - Vos, A. W. F.
AU - Vos, C. G.
AU - Vos, G. A.
AU - de Vos, B.
AU - Voûte, M. T.
AU - Vriens, B. H. R.
AU - Vriens, P. W. H. E.
AU - de Vries, D. K.
AU - de Vries, J. P. P. M.
AU - de Vries, M.
AU - de Vries, A. C.
AU - van der Waal, C.
AU - Waasdorp, E. J.
AU - de Vries, B. M. Wallis
AU - van Walraven, L. A.
AU - van Wanroi, J. L.
AU - Warlé, M. C.
AU - van Weel, V.
AU - van Well, A. M. E.
AU - Welten, G. M. J. M.
AU - Wever, J. J.
AU - Wiersema, A. M.
AU - Wikkeling, O. R. M.
AU - Willaert, W. I. M.
AU - Wille, J.
AU - Willems, M. C. M.
AU - Willigendael, E. M.
AU - Wilschut, E. D.
AU - Wisselink, W.
AU - Witte, M. E.
AU - Wittens, C. H. A.
AU - Wong, C. Y.
AU - Yazar, O.
AU - Yeung, K. K.
AU - Zeebregts, C. J. A. M.
AU - van Zeeland, M. L. P.
AU - van den Berg, M.
N1 - Publisher Copyright: © 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Objective: We evaluate nationwide perioperative outcomes of complex EVAR and assess the volume-outcome association of complex EVAR. Summary of Background Data: Endovascular treatment with fenestrated (FEVAR) or branched (BEVAR) endografts is progressively used for excluding complex aortic aneurysms (complex AAs). It is unclear if a volumeoutcome association exists in endovascular treatment of complex AAs (complex EVAR). Methods: All patients prospectively registered in the Dutch Surgical Aneurysm Audit who underwent complex EVAR (FEVAR or BEVAR) between January 2016 and January 2020 were included. The effect of annual hospital volume on perioperative mortality was examined using multivariable logistic regression analyses. Patients were stratified into quartiles based on annual hospital volume to determine hospital volume categories. Results: We included 694 patients (539 FEVAR patients, 155 BEVAR patients). Perioperative mortality following FEVAR was 4.5% and 5.2% following BEVAR. Postoperative complication rates were 30.1% and 48.7%, respectively. The first quartile hospitals performed <9 procedures/ yr; second, third, and fourth quartile hospitals performed 9-12, 13-22, and 23 procedures/yr. The highest volume hospitals treated significantly more complex patients. Perioperative mortality of complex EVAR was 9.1% in hospitals with a volume of <9, and 2.5% in hospitals with a volume of 13 (P = 0.008). After adjustment for confounders, an annual volume of 13 was associated with less perioperative mortality compared to hospitals with a volume of <9. Conclusions: Data from this nationwide mandatory quality registry shows a significant effect of hospital volume on perioperative mortality following complex EVAR, with high volume complex EVAR centers demonstrating lower mortality rates.
AB - Objective: We evaluate nationwide perioperative outcomes of complex EVAR and assess the volume-outcome association of complex EVAR. Summary of Background Data: Endovascular treatment with fenestrated (FEVAR) or branched (BEVAR) endografts is progressively used for excluding complex aortic aneurysms (complex AAs). It is unclear if a volumeoutcome association exists in endovascular treatment of complex AAs (complex EVAR). Methods: All patients prospectively registered in the Dutch Surgical Aneurysm Audit who underwent complex EVAR (FEVAR or BEVAR) between January 2016 and January 2020 were included. The effect of annual hospital volume on perioperative mortality was examined using multivariable logistic regression analyses. Patients were stratified into quartiles based on annual hospital volume to determine hospital volume categories. Results: We included 694 patients (539 FEVAR patients, 155 BEVAR patients). Perioperative mortality following FEVAR was 4.5% and 5.2% following BEVAR. Postoperative complication rates were 30.1% and 48.7%, respectively. The first quartile hospitals performed <9 procedures/ yr; second, third, and fourth quartile hospitals performed 9-12, 13-22, and 23 procedures/yr. The highest volume hospitals treated significantly more complex patients. Perioperative mortality of complex EVAR was 9.1% in hospitals with a volume of <9, and 2.5% in hospitals with a volume of 13 (P = 0.008). After adjustment for confounders, an annual volume of 13 was associated with less perioperative mortality compared to hospitals with a volume of <9. Conclusions: Data from this nationwide mandatory quality registry shows a significant effect of hospital volume on perioperative mortality following complex EVAR, with high volume complex EVAR centers demonstrating lower mortality rates.
KW - complex AAA
KW - endovascular
KW - mortality
KW - volume-outcome
UR - http://www.scopus.com/inward/record.url?scp=85148248588&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/SLA.0000000000005337
DO - https://doi.org/10.1097/SLA.0000000000005337
M3 - Article
C2 - 34913891
SN - 0003-4932
VL - 277
SP - E678-E688
JO - Annals of surgery
JF - Annals of surgery
IS - 3
ER -