title: Single versus multi-specialty operative teams: association with perioperative mortality after endovascular abdominal aortic aneurysm repair.
abstract: Endovascular abdominal aortic aneurysm repair (EVAR) requires both endovascular and open surgical skills. Although usually performed by a single operating specialist, EVAR may alternatively involve multiple teams from different specialties performing separate procedural components.  We examined the relative frequencies of single versus multi-specialty EVAR in the 2005 to 2008 American College of Surgeons National Surgical Quality Improvement Participant Use Datafile and explored the influence of multi-specialty EVAR on 30-day mortality. EVARs were identified and  classified as single or multiple-specialty procedures based on Current Procedural Terminology codes. Baseline and procedural characteristics were compared using χ(2) or Fisher's exact test for categorical variables and t test for continuous variables. The association between  multi-specialty EVAR and 30-day mortality was examined using a multivariate logistic regression model. Of 7269 EVAR patients identified, 7086 were single and 183 were multi-specialty. Multi-specialty patients had higher frequency of brachial or iliac artery exposure and longer operative times,  but were otherwise similar in baseline and procedural characteristics. In the multivariate model, multi-specialty EVAR was associated with increased risk of 30-day mortality (odds ratio 2.35; 95% confidence interval 1.08-5.11; P value 0.031). Multi-specialty participation in  EVAR procedures is associated with significantly higher 30-day mortality. Further research is warranted to determine whether multi-specialty participation reflects provider experience, institutional protocols, procedural complexity, non-surgical or other factors.
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Mazer
authors.forename: Elliot L
authors.initials: EL
authors.lastname: Chiakof
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Edwards
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Corriere
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010348:Patient Care Team; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D058996:Quality Improvement; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology