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Assoziation zwischen Operationsvolumen und postoperativer Mortalität bei der elektiven offenen Versorgung infrarenaler abdomineller Aortenaneurysmen: systematische Übersichtsarbeit

Association between operation volume and postoperative mortality in the elective open repair of infrarenal abdominal aortic aneurysms: systematic review

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A Review to this article was published on 11 December 2020

A Kommentar to this article was published on 09 September 2020

Zusammenfassung

Hintergrund

Für viele chirurgische Eingriffe konnte eine inverse Assoziation zwischen Fallzahl pro Krankenhaus und Operateur und perioperativer Mortalität gezeigt werden. Auch für die offene Versorgung infrarenaler Aortenaneurysmen gibt es eine größere Anzahl von Studien zu dieser Fragestellung.

Ziel der Arbeit

In einer systematischen Übersichtsarbeit soll die verfügbare Datenlage zur Assoziation zwischen Fallzahl pro Krankenhaus und Operateur und perioperativer Mortalität bei der elektiven offenen Versorgung infrarenaler Aortenaneurysmen dargestellt werden.

Material und Methoden

In den Datenbanken PubMed, Cochrane Library, Web of Science Core Collection, CINAHL, Current Contents Medizin (CCMed) und ClinicalTrials.gov wurde eine systematische Recherche mittels definierter Schlüsselwörter durchgeführt. Aus den Treffern wurden alle Originalarbeiten eingeschlossen, die die elektive offene Versorgung eines infrarenalen Aortenaneurysmas in einem „high volume“-Zentrum mit einem „low volume“-Zentrum oder durch einen „high volume“-Chirurgen mit einem „low volume“-Chirurgen, wie in der jeweiligen Studie definiert, verglichen.

Ergebnisse

Nach Deduplizierung erbrachte die Literatursuche 1021 Treffer. Von diesen erfüllten 60 Publikationen die Einschlusskriterien. Dabei zeigten 37/43 Studien eine niedrigere Mortalität in „high-volume“- verglichen mit „low-volume“-Zentren und 14/17 Vergleichen eine niedrigere Mortalität für „high volume“- verglichen mit „low volume“-Chirurgen. Die Effektmaße, in aller Regel Odds Ratios, lagen zwischen 0,37 und 0,99 für Fallzahl pro Krankenhaus und 0,31 und 0,92 für Fallzahl pro Chirurg. Hinsichtlich der Schwellenwerte zur Definition von „high volume“ und „low volume“ zeigte sich eine deutliche Heterogenität zwischen den einzelnen Studien.

Diskussion

Die verfügbare Datenlage zur Assoziation zwischen Fallzahl pro Krankenhaus und Operateur und perioperativer Mortalität bei der elektiven offenen Versorgung infrarenaler Aortenaneurysmen zeigt übereinstimmend, dass in „high volume“-Zentren bzw. von „high volume“-Chirurgen durchgeführte Eingriffe mit einer niedrigeren Mortalität assoziiert sind. Um ein möglichst gutes Outcome im Sinne einer niedrigen perioperativen Mortalität bei der offenen Versorgung infrarenaler Aortenaneurysmen zu gewährleisten, sollte eine Zentralisierung mit hohen Fallzahlen pro Krankenhaus und Chirurg angestrebt werden.

Abstract

Background

An inverse association between the case volume per hospital and surgeon and perioperative mortality has been shown for many surgical interventions. There are numerous studies on this issue for the open treatment of infrarenal aortic aneurysms.

Aim

To present the available data on the association between the case volume per hospital and surgeon and perioperative mortality in the elective open repair of infrarenal aortic aneurysms in a systematic review.

Materials and methods

Using the PubMed, Cochrane Library, Web of Science Core Collection, CINAHL, Current Contents Medicine (CCMed), and ClinicalTrials.gov databases, a systematic search was performed using defined keywords. From the search results, all original papers were included that compared the elective open repair of an infrarenal aortic aneurysm in a “high volume” center with a “low volume” center or by a “high volume” surgeon with a “low volume” surgeon, as defined in the respective study.

Results

After deduplication, the literature search yielded 1021 hits of which 60 publications met the inclusion criteria. Of these, 37/43 studies showed a lower mortality in “high volume” compared to “low volume” centers and 14/17 comparisons showed a lower mortality for “high volume” compared to “low volume” surgeons. The effect measures, usually odds ratios, ranged from 0.37 to 0.99 for volume per hospital and 0.31 to 0.92 for volume per surgeon. Regarding the threshold values for the definition of “high volume” and “low volume,” a clear heterogeneity was shown between the individual studies.

Discussion

The available data on the association between the case volume per hospital and surgeon and perioperative mortality in the elective open repair of infrarenal aortic aneurysms show that interventions performed in “high volume” centers or by “high volume” surgeons are associated with lower mortality. To ensure the best possible outcome in terms of low perioperative mortality in the open repair of infrarenal aortic aneurysms, the aim should be centralization with high case volume per hospital and surgeon.

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  1. Universitätsklinik und Poliklinik für Viszerale, Gefäß- und Endokrine Chirurgie, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland

    U. Ronellenfitsch

  2. Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    U. Ronellenfitsch,  K. Meisenbacher,  M. Ante &  D. Böckler

  3. Fachinformation Medizin und Gesundheitsberufe, Roonstr. 17, 76137, Karlsruhe, Deutschland

    M. Grilli

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U. Ronellenfitsch, K. Meisenbacher, M. Ante, M. Grilli und D. Böckler geben an, dass kein Interessenkonflikt besteht.

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Ronellenfitsch, U., Meisenbacher, K., Ante, M. et al. Assoziation zwischen Operationsvolumen und postoperativer Mortalität bei der elektiven offenen Versorgung infrarenaler abdomineller Aortenaneurysmen: systematische Übersichtsarbeit. Gefässchirurgie 25, 450–461 (2020). https://doi.org/10.1007/s00772-020-00671-y

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