title: The effect of surgeon specialization on outcomes after ruptured abdominal aortic aneurysm repair.
abstract: OBJECTIVE
  Although mortality after elective abdominal aortic aneurysm (AAA) repair has steadily declined, operative mortality for a ruptured AAA (rAAA) remains high. Repair of rAAA at hospitals with a higher elective aneurysm workload has been associated with lower mortality rates irrespective of the mode of treatment. This study sought to determine the association between surgeon specialization and outcomes after rAAA repair.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Project database from 2005 to 2010 was used to examine the 30-day mortality and morbidity outcomes of patients undergoing rAAA repair by vascular and general surgeons. Multivariable logistic regression analysis was performed for each death and morbidity, adjusting for all independently predictive preoperative risk factors. Survival curves were compared using the log-rank test.
  
  
  RESULTS
  We identified 1893 repairs of rAAAs, of which 1767 (96.1%) were performed by vascular surgeons and 72 (3.9%) were performed by general surgeons. There were no significant differences between patients operated on by general vs vascular surgeons in preoperative risk factors or method of repair. Overall 30-day mortality was 34.3% (649 of 1893). After risk adjustment, mortality was significantly lower in the vascular surgery group compared with the general surgery group (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.30-0.86; P = .011). The risk of returning to the operating room (OR, 0.58; 95% CI, 0.35-0.97; P = .038), renal failure (OR, 0.54; 95% CI, 0.31-0.95; P = .034), and a cardiac complication (OR, 0.53; 95% CI, 0.28-0.99; P = .047) were all significantly less in the vascular surgery group.
  
  
  CONCLUSIONS
  Despite similar preoperative risk factors profiles, patients who were operated on by vascular surgeons had lower mortality, less frequent returns to the operating room, and decreased incidences of postoperative renal failure and cardiac events. These data add weight to the case for further centralization of vascular services.
authors.affiliation: Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, Mass.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Hawkins
authors.affiliation: Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, Mass.
authors.forename: Ann D
authors.initials: AD
authors.lastname: Smith
authors.affiliation: Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, Mass.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Schaumeier
authors.affiliation: Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, Mass.
authors.forename: Marit S
authors.initials: MS
authors.lastname: de Vos
authors.affiliation: Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, Mass.
authors.forename: Nathanael D
authors.initials: ND
authors.lastname: Hevelone
authors.affiliation: Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: llnguyen@partners.org.
authors.forename: Louis L
authors.initials: LL
authors.lastname: Nguyen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D013502:General Surgery; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000209:etiology; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013038:Specialization; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality