title: Debate: whether abdominal aortic aneurysm surgery should be centralized at higher-volume centers.
abstract: Volume-outcome relationships in vascular surgery have become increasingly relevant in recent years. At the individual surgeon level, increased experience has been linked with improved patient outcomes after volume-outcome and learning curve analyses. At the hospital level, further analyses have generally shown a similar relationship linking the busier hospitals with improved outcomes. However, is this relationship sufficient and robust enough to support important health care delivery decisions regarding centralization of care? In England, such information has helped to shape the vascular surgery reorganization process in London. The following discussion presents the advantages and disadvantages of the practical use of such information.
authors.affiliation: St. George's Vascular Institute, St. George's, NHS Trust, London, UK. matt.thompson@stgeorges.nhs.uk
authors.forename: Matthew
authors.initials: M
authors.lastname: Thompson
authors.forename: Peter
authors.initials: P
authors.lastname: Holt
authors.forename: Ian
authors.initials: I
authors.lastname: Loftus
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Forbes
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D002497:Centralized Hospital Services / Q000458:organization & administration*; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D009937:Organizational Objectives; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D057240:Patient Preference; D019984:Quality Indicators, Health Care; D012040:Regional Health Planning / Q000458:organization & administration*; D018570:Risk Assessment; D014186:Transportation; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000458:organization & administration*; D016526:Workload