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. 2002 Apr;235(4):579-85.
doi: 10.1097/00000658-200204000-00017.

Variation in death rate after abdominal aortic aneurysmectomy in the United States: impact of hospital volume, gender, and age

Justin B Dimick  1 , James C Stanley, David A Axelrod, Andris Kazmers, Peter K Henke, Lloyd A Jacobs, Thomas W Wakefield, Lazar J Greenfield, Gilbert R Upchurch Jr
Affiliations

Variation in death rate after abdominal aortic aneurysmectomy in the United States: impact of hospital volume, gender, and age

Justin B Dimick et al. Ann Surg. 2002 Apr.

Abstract

Objective: To determine whether high-volume hospitals (HVHs) have lower in-hospital death rates after abdominal aortic aneurysm (AAA) repair compared with low-volume hospitals (LVHs).

Summary background data: Select statewide studies have shown that HVHs have superior outcomes compared with LVHs for AAA repair, but they may not be representative of the true volume-outcome relationship for the entire United States.

Methods: Patients undergoing repair of intact or ruptured AAAs in the Nationwide Inpatient Sample (NIS) for 1996 and 1997 were included (n = 13,887) for study. The NIS represents a 20% stratified random sample representative of all U.S. hospitals. Unadjusted and case mix-adjusted analyses were performed.

Results: The overall death rate was 3.8% for intact AAA repair and 47% for ruptured AAA repair. For repair of intact AAAs, HVHs had a lower death rate than LVHs. The death rate after repair of ruptured AAA was also slightly lower at HVHs. In a multivariate analysis adjusting for case mix, having surgery at an LVH was associated with a 56% increased risk of in-hospital death. Other independent risk factors for in-hospital death included female gender, age older than 65 years, aneurysm rupture, urgent or emergent admission, and comorbid disease.

Conclusions: This study from a representative national database documents that HVHs have a significantly lower death rate than LVHs for repair of both intact and ruptured AAA. These data support the regionalization of patients to HVHs for AAA repair.

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Figures

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Figure 1. Comparison of in-hospital death rates by age group and gender for patients undergoing repair of intact abdominal aortic aneurysm in the United States, 1996 to 1997. There is a significant difference in the death rate between men and women until they reach an age greater than 80 years old. *P < .05.
None
Figure 2. Comparison of in-hospital death rates by age group for patients undergoing repair of intact abdominal aortic aneurysm at high- and low-volume hospitals in the United States, 1996 to 1997. Patients older than and younger than 65 years old have significantly lower death rates at high-volume hospitals versus low-volume hospitals. *P < .05.
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Comment in

  • Aortic aneurysms: an update.
    Balint TB, Bogey WM Jr, Powell CS, Parker FM, Brown PM Jr. Balint TB, et al. Curr Surg. 2003 May-Jun;60(3):246-51. doi: 10.1016/s0149-7944(02)00790-0. Curr Surg. 2003. PMID: 15212058 No abstract available.

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