A systematic review of the effect of surgeon and hospital volume on survival in aortic, thoracic and fenestrated endovasular aneurysm repair.

Abstract

BACKGROUND\nEndovascular aneurysm repair (EVAR) is becoming a mainstay in vascular surgery both in metropolitan and regional hospitals. This review aims to assess the impact of hospital and surgeon volume on perioperative mortality specific to this surgery type in order to support the use of this treatment modality extensively.\n\n\nMETHODS\nA literature search was performed on multiple dedicated medical databases using a detailed search strategy with terms focusing on hospital volume and endovascular aneurysm repairs. Inclusion and exclusion criteria were used to screen and evaluate suitable sources, focusing on operators and hospitals performing EVARs and the morbidity/mortality as outcomes. The results were then appraised using a PRISMA framework.\n\n\nRESULTS\n45 articles were reviewed. Twelve articles met inclusion criteria for complete review. There was no level 1 evidence, and only a single systematic review and meta-analysis.\n\n\nDISCUSSION\nEVAR and thoracic EVAR (TEVAR) perioperative mortality had no correlation with hospital volume. Limited evidence was presented for fenestrated EVAR (FEVAR) where a mortality risk based on hospital volume remains unanswered. Open procedures for aneurysm repair had perioperative mortality outcomes which grossly correlated with hospital volume, supporting their use in high volume centres.\n\n\nCONCLUSION\nWith open aneurysm repairs having increased mortality risk in low volume centres, and endovascular treatment options gaining momentum, there is considerable support in the use of EVAR and TEVAR in smaller regional centres safely and effectively. There is very limited evidence in the use of FEVAR which remains unanswered but presents a significant opportunity for research.