Association of Hospital Volume with Perioperative Mortality of Endovascular Repair of Complex Aortic Aneurysms: A Nationwide Cohort Study

Anna J Alberga; Gerdine C I von Meijenfeldt; Vinamr Rastogi; Jorg L de Bruin; Jan J Wever; Joost A van Herwaarden; Jaap F Hamming; Constantijn E V B Hazenberg; Jan van Schaik; Barend M E Mees; Maarten J van der Laan; Clark J Zeebregts; Geert W H Schurink; Hence J M Verhagen; Dutch Society of Vascular Surgery*, the Steering Committee of the Dutch Surgical Aneurysm Audit, the Dutch Institute for Clinical Auditing

doi:10.1097/SLA.0000000000005337

Association of Hospital Volume with Perioperative Mortality of Endovascular Repair of Complex Aortic Aneurysms: A Nationwide Cohort Study

Ann Surg. 2021 Dec 14. doi: 10.1097/SLA.0000000000005337. Online ahead of print.

Authors

Anna J Alberga¹, Gerdine C I von Meijenfeldt, Vinamr Rastogi, Jorg L de Bruin, Jan J Wever, Joost A van Herwaarden, Jaap F Hamming, Constantijn E V B Hazenberg, Jan van Schaik, Barend M E Mees, Maarten J van der Laan, Clark J Zeebregts, Geert W H Schurink, Hence J M Verhagen; Dutch Society of Vascular Surgery*, the Steering Committee of the Dutch Surgical Aneurysm Audit, the Dutch Institute for Clinical Auditing

Affiliation

¹ Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands Department of Vascular Surgery, Haga Teaching Hospital, The Hague, the Netherlands Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands.

PMID: 34913891
DOI: 10.1097/SLA.0000000000005337

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 volume-outcome 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 the 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.