Discrepant Effects of Case Volume on Mortality After Elective and Ruptured Abdominal Aortic Aneurysm Repair

To evaluate the case volume (CV) and mortality outcomes relationship after both open (OAR) endovascular repair (EVAR) of elective (e) ruptured (r) abdominal aortic aneurysm using contemporary administrative database. Healthcare Cost Utilization Project Database for NY (2016) NJ/MD/FL (2016-2017) were queried International Classification Disease-10th edition to identify OAR EVAR. Hospitals categorized into quartiles (Q) per overall (EVAR+OAR) OAR-alone volume. Cox regression adjusted confounding factors was used estimate hazard ratios (HRs) mortality. A total 8825 patients (mean age, 73.5±9.5 years; 6861 [77.7%] male) underwent 1355 OARs 7470 EVARs. Overall CV had no impact on in-hospital across eEVAR, rEVAR eOAR. However, rOAR rates in highest-volume (Q4) hospitals significantly lower compared 3 Q (23.1% vs 44.7%; P < .001). When analyzed volume, same findings observed (22.0% 41.6%; .001) (Table). Furthermore, Q4 hospitals, between (30.0%) (37.2%) similar overall-volume analysis (HR, 1.64; 95% confidence interval [CI], 0.91-2.9; = .1), whereas it higher (39.0%) than (22.0%) 2.3; CI, 1.02-5.34; .05) (Fig). Mortality rEVAR, eOAR are independent CV. rOAR, with at least comparable those rEVAR. should be deferred high OAR-volume centers. Further studies warranted determine accountable differences.TableVolume by typePer volumeQ1, % (1-15.5/year)Q2, (16-30/year)Q3, (31-52/year)Q4, (≥53/year)TotalP valuerOAR52.540.440.423.137.2<.001eOAR8.88.44.99.28.0.21rEVAR24.820.529.626.525.3.63eEVAR1.11.40.70.91.0.15Per VolumeQ1, (0.5-3/year)Q2, (4-8/year)Q3, (9-25/year)Q4, (≥26/year)TotalP valuerOAR52.934.629.722.037.2<.001eOAR9.75.97.110.08.0.13rEVAR23.222.524.230.023.9.66eEVAR1.10.71.01.71.0.28E, Elective; EVAR, repair; OAR, r, ruptured. Open table a new tab