This article is more than 5 years old. Information may no longer be current.
Center volume did not influence outcomes with TEVAR
Click Here to Manage Email Alerts
Thoracic endovascular aortic repair can be safely performed at low- and high-volume hospitals regardless of teaching status, whereas open surgery should be performed only at high-volume hospitals, study researchers found.
To evaluate the effect of case volume and hospital teaching status on clinical outcomes after thoracic endovascular aortic repair (TEVAR) on intact descending thoracic aortic aneurysms (DTA), researchers applied results from the Medicare Provider Analysis and Review (MEDPAR) data set from 2004 to 2007. Hospitals were defined as high volume (at least eight DTA cases per year) or low volume (fewer than eight cases per year) and as teaching or nonteaching facilities.
DTA repair increased from 1,375 in 2004 to 1,987 in 2007. In 2004, the year before initial commercial availability of TEVAR, 95% of hospitals did open repair compared with 57% in 2007 (P<.001), whereas those performing TEVAR increased from 24% to 76% (P<.001). Although open repairs were done at 75% of facilities in 2004, that rate dropped to 39% in 2007 (P<.01). Open repair rates at low-volume hospitals decreased from 56% in 2004 to 44% in 2007 (P<.01), whereas TEVAR increased from 24% in 2004 to 51% in 2007 (P<.01).
Mortality for open repair was 15% at low-volume hospitals compared with 11% at high-volume hospitals (P<.01). TEVAR mortality was similar between low- and high-volume hospitals (low, 3.9% vs. 5.5%; P=.43). Low-volume hospitals were independently associated with increased mortality after open repair (OR=1.4; 95% CI, 1.1-1.8) but not after TEVAR.
Hospital teaching status was not associated with mortality or complications after open repair or TEVAR.
“Although not specifically studied, this implies open surgical repair in similar-risk patients at [low-volume] and [high-volume] centers, and therefore, a health care systems-based (operative and postoperative) advantage at [high-volume] centers,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts