title: Meta-analysis and systematic review of the relationship between surgeon annual caseload and mortality for elective open abdominal aortic aneurysm repairs.
abstract: OBJECTIVE
  To assess the relationship between the annual caseload of elective open abdominal aortic aneurysm (AAA) repairs performed by individual surgeons and mortality.
  
  
  METHODS
  PubMed, EMBASE, and the Cochrane library were searched for articles on the volume-outcome relationship in AAA surgery. The review conformed to the QUOROM statement. The data were meta-analyzed to compare the mortality rates of higher- and lower-volume surgeons. A critical volume threshold was calculated for better practice.
  
  
  RESULTS
  Fourteen relevant articles were retrieved from the searches. A systematic review was performed, and six were meta-analyzed. A total of 115,273 elective open AAA repairs were considered, with a mean mortality rate of 5.56%. Significant relationships between higher surgeon caseload and lower mortality were demonstrated in 12 of 14 studies. From the meta-analysis, the pooled effect estimate was an odds ratio of 0.56 (95% confidence interval, 0.54-0.57) in favor of higher-volume surgeons. A critical volume threshold was identified as 13 cases per annum for individual surgeons.
  
  
  CONCLUSIONS
  As surgeons performed higher annual volumes of elective open AAA repairs, significantly lower mortality rates were demonstrated. Surgeons wishing to perform elective AAA repairs should achieve a minimum case volume of 13 repairs per annum.
authors.affiliation: St George's Vascular Institute, St James' Wing, St George's Hospital, London, United Kingdom.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Young
authors.forename: Peter J E
authors.initials: PJ
authors.lastname: Holt
authors.forename: Jan D
authors.initials: JD
authors.lastname: Poloniecki
authors.forename: Ian M
authors.initials: IM
authors.lastname: Loftus
authors.forename: Matt M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000401:mortality*; D002983:Clinical Competence; D017558:Elective Surgical Procedures / Q000401:mortality; D006801:Humans; D016017:Odds Ratio; D009864:Ontario / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010561:Personnel Staffing and Scheduling; D018570:Risk Assessment; D013043:Specialties, Surgical / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000401:mortality*; D000078329:Workforce; D016526:Workload