Volume-outcome relationships in vascular surgery: the current status.
Vascular surgery has been widely practiced in hospitals within a general surgical service, although the consequent workload of individual vascular units has been small. There is an increasing body of evidence in favor of a positive relationship between hospital and surgeon volumes and the outcome of arterial surgery. These relationships suggest that vascular surgical procedures might be best placed within a centralized model of care to increase volume and thereby attain best outcomes. This systematic review appraises the current evidence for volume-outcome relationships in vascular surgery from a number of healthcare systems to examine the basis for centralization of vascular surgical services. The index procedures addressed in this review are open or endovascular repair of abdominal aortic aneurysm (AAA), ruptured AAA, descending thoracic aortic aneurysm, and thoracoabdominal aortic aneurysm, along with carotid endarterectomy and lower extremity arterial bypass.
Karthikesalingam
Alan
A
Department of Outcomes Research, St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK.
Hinchliffe
Robert J
RJ
Loftus
Ian M
IM
Thompson
Matt M
MM
Holt
Peter J
PJ
D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001019:Aortic Rupture / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000401:mortality / Q000601:surgery*; D002497:Centralized Hospital Services; D002983:Clinical Competence / Q000706:statistics & numerical data; D003251:Constriction, Pathologic; D016894:Endarterectomy, Carotid / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D016526:Workload / Q000706:statistics & numerical data