Journal article
Variation in death rate after abdominal aortic aneurysmectomy in the United States: Impact of hospital volume, gender, and age
Annals of surgery, Vol.235(4), pp.579-585
2002
DOI: 10.1097/00000658-200204000-00017
PMCID: PMC1422474
PMID: 11923615
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.
Details
- Title: Subtitle
- Variation in death rate after abdominal aortic aneurysmectomy in the United States: Impact of hospital volume, gender, and age
- Creators
- Justin B Dimick - Wayne State UniversityJames C Stanley - Wayne State UniversityDavid A Axelrod - University of Michigan–Ann ArborAndris Kazmers - University of Michigan–Ann ArborPeter K Henke - Wayne State UniversityLloyd A Jacobs - University of Michigan–Ann ArborThomas W Wakefield - Wayne State UniversityLazar J Greenfield - Wayne State UniversityGilbert R Upchurch - University of Michigan–Ann Arbor
- Resource Type
- Journal article
- Publication Details
- Annals of surgery, Vol.235(4), pp.579-585
- Publisher
- Lippincott
- DOI
- 10.1097/00000658-200204000-00017
- PMID
- 11923615
- PMCID
- PMC1422474
- ISSN
- 0003-4932
- eISSN
- 1528-1140
- Language
- English
- Date published
- 2002
- Academic Unit
- Surgery
- Record Identifier
- 9984321862802771
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