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

Abstract

Background: Endovascular 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 to support the use of this treatment modality extensively.

Methods: A literature search was performed on multiple dedicated medical databases using a detailed search strategy with terms focusing on hospital volume and EVARs. 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.

Results: We reviewed 45 articles. Twelve articles met inclusion criteria for complete review. There was no level 1 evidence, and only a single systematic review and meta-analysis. EVAR and thoracic EVAR perioperative mortality had no correlation with hospital volume. Limited evidence was presented for fenestrated EVAR, where a mortality risk based on hospital volume remains unanswered. Open procedures for aneurysm repair had perioperative mortality outcomes that grossly correlated with hospital volume, supporting their use in high-volume centers.

Conclusions: With open aneurysm repairs having an increased mortality risk in low-volume centers, and endovascular treatment options gaining momentum, there is considerable support for the use of EVAR and thoracic EVAR in smaller regional centers safely and effectively. There is very limited evidence in the use of fenestrated EVAR, which remains unanswered, but presents a significant opportunity for research.

Keywords: Endovascular aneurysm repair; Endovascular surgery; Hospital volume.