title: The impact of hospital volume on the development of infectious complications after elective abdominal aortic surgery in the Medicare population.
abstract: OBJECTIVE
  A relationship exists between higher hospital volume and lower mortality, yet the impact of hospital volume on infectious complications after elective abdominal aortic aneurysm (AAA) repair is unknown.
  
  
  METHODS
  The Medicare database (2005-2007) was utilized. Top 10% for volume were categorized as high-volume (HV) and compared to low-volume (LV) centers for infectious complications and utilization.
  
  
  RESULTS
  A total of 42 155 endovascular aneurysm repair (EVAR) and 17 210 open AAA were identified. Mortality in HV was significantly lower than in LV after EVAR and open AAA. After EVAR, HV had lower than LV rates of overall infection (3.10% vs 3.51%; P = .021), PNA (0.94% vs 1.27%, P = .002), and sepsis (0.31% vs 0.45%; P = .03). Length of stay (LOS) and total hospital charges were significantly lower at HV compared to LV after both EVAR and open AAA.
  
  
  CONCLUSIONS
  For Medicare beneficiaries, undergoing elective AAA repair at hospitals performing higher volume significantly reduced postoperative infectious complications and hospital resource utilization. Further analysis identifying systematic reasons for disparities may offer cost savings and improve outcomes.
authors.affiliation: Department of Surgery, Robert Wood Johnson Medical School, The Surgical Outcomes Research Group, New Brunswick, NJ 08903, USA. tvogel@excite.com
authors.forename: Todd R
authors.initials: TR
authors.lastname: Vogel
authors.forename: Viktor Y
authors.initials: VY
authors.lastname: Dombrovskiy
authors.forename: Alan M
authors.initials: AM
authors.lastname: Graham
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Lowry
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000191:economics / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D017046:Cost Savings; D017558:Elective Surgical Procedures / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D005260:Female; D017721:Hospital Costs; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014552:Urinary Tract Infections / Q000209:etiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000191:economics / Q000401:mortality