What is the published evidence of an association between hospital volume and operative mortality for surgical repair (open and endovascular) of unruptured and ruptured abdominal aortic aneurysms?

McIntosh H
Record ID 32013000476
Authors' recommendations: Summary This scoping report focused on studies examining the association between hospital volume and mortality following elective repair of unruptured aneurysms and repair of ruptured aneurysms. The available evidence appears to support a hospital volume-outcome association for elective OSR in so far as the majority of published primary studies have reported statistically significant findings, whereas the evidence from studies of ruptured aneurysm repair is inconsistent. Very little secondary evidence relating to hospital volume and EVAR was identified. The evidence sources reviewed identified only observational studies from which it was not possible to ascertain whether the observed hospital volume-outcome relationship for elective AAA repair was causal. The observed associations represent only the average performance of low and high volume hospitals and do not capture the variability that suggests that hospital volume is not the only factor driving mortality rates. There was insufficient evidence in the hospital volume outcome literature to inform conclusions about the influence that other factors associated with high hospital volume, such as processes of care, might have on surgical mortality. The evidence reviewed was not sufficiently robust to allow the determination of a definite threshold for categorising hospitals as high or low volume, or an optimal hospital volume above which there is no reduction in mortality. The guidelines and frameworks identified variously recommend a minimum of either 20 or 50 elective AAA repairs per unit per year, whether by OSR or EVAR; and, with respect to EVAR specifically, a minimum of 20–30 procedures per unit per year.
Project Status: Completed
Year Published: 2012
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Scotland, United Kingdom
MeSH Terms
  • Aortic Aneurysm, Abdominal
  • Hospital Mortality
  • Length of Stay
  • Hospitals
  • Endovascular Procedures
Organisation Name: Scottish Health Technologies Group
Contact Address: Scottish Health Technologies Group, Delta House, 50 West Nile Street, Glasgow, G1 2NP Tel: 0141 225 6998
Contact Name: his.shtg@nhs.scot
Contact Email: his.shtg@nhs.scot
Copyright: Healthcare Improvement Scotland
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