[Case load and quality indicators in the treatment of abdominal aortic aneurysms]

BACKGROUND

The MTL30 (mortality, transfer, length of stay) was proposed as a surrogate parameter for evaluating the quality of large and potentially complication-prone visceral surgical interventions.

OBJECTIVE

The aim of this study was to find out to what extent the MTL30 can be correlated with the results of the abdominal aortic aneurysm (AAA) registry of the German Institute for Vascular Health Research (DIGG) of the German Society for Vascular Surgery and Vascular Medicine (DGG) and with the case volume of the participating hospitals.

MATERIAL AND METHODS

Elective endovascular abdominal aortic aneurysm repair (EVAR) was performed in 14,282 patients and open repair (OAR) in 3923 patients. Case volume of the treating hospitals, hospital mortality, length of stay and transfer to another acute care hospital were determined 30 days after the index intervention.

RESULTS

The hospital mortality was 1.3% for EVAR and 4.9% for OAR (p = 0.000), the MTL30 was 5.0% and 14.4%, respectively (p = 0.000). For EVAR, no relationship between case volume and hospital mortality (quintile 1: 1.0%; quintile 5: 1.3%) as well as case volume and MTL30 (quintile 1: 5.3%; quintile 5: 5.3%) could be demonstrated. Also in OAR there was no significant relationship between case volume and hospital mortality (quintile 1: 5.8%, quintile 5: 3.5%; p = 0.505) and case volume and MTL30 (quintile 1: 16.4%, quintile 5: 12.2%, p = 0.110). With a hospital mortality rate of 7.2% (5-10%) the MTL30 for OAR was 17.6%. In both EVAR and OAR, the length of stay correlated significantly with hospital mortality and MTL30.

DISCUSSION

A clear relationship between hospital case volume and hospital mortality could not be shown in the AAA registry of the DIGG. The same was true for the MTL30. It remains to be seen whether the MTL30 offers an additional benefit compared to the recording of hospital mortality and inpatient length of stay as a quality parameter.

Estimating returns to hospital volume: Evidence from advanced cancer surgery

High-volume hospitals typically perform better than low-volume hospitals. In this paper, we study whether such patterns reflect a causal effect of case volume on patient outcomes. To this end, we exploit closures and openings of entire cancer clinics in Swedish hospitals which provides sharp and arguably exogenous variation in case volumes. Using detailed register data on more than 100,000 treatment episodes of advanced cancer surgery, our results suggest substantial positive effects of operation volume on survival. Complementary analyses point to learning-by-doing as an important explanation.

Different quality of treatment in retroperitoneal sarcomas (RPS) according to hospital-case volume and surgeon-case volume: a retrospective regional analysis in Italy

Background

Retroperitoneal sarcomas (RPS) should be surgically managed in specialized sarcoma centers. However, it is not clearly demonstrated if clinical outcome is more influenced by Center Case Volume (CCV) or by Surgeon Case Volume (SCV). The aim of this study is to retrospectively explore the relationship between CCV and SCV and the quality of surgery in a wide region of Northern Italy.

Methods

We retrospectively collected data about patients M0 surgically treated for RPSs in 22 different hospitals from 2006 to 2011, dividing them in two hospital groups according to sarcoma clinical activity volume (HCV, high case volume or LCV, low case volume hospitals). The HCV group (> 100 sarcomas observed per year) included a Comprehensive Cancer Center (HVCCC) with a high sarcoma SCV (> 20 cases/year), and a Tertiary Academic Hospital (HVTCA) with multiple surgeon teams and a low sarcoma SCV (≤ 5 cases/year for each involved surgeon). All other hospitals were included in the LCV group (< 100 sarcomas observed per year).

Results

Data regarding 138 patients were collected. Patients coming from LCV hospitals (66) were excluded from the analysis as prognostic data were frequently not available. Among the 72 remaining cases of HCV hospitals 60% of cases had R0/R1 margins, with a more favorable distribution of R0/R1 versus R2 in HVCCC compared to HVTCA.

Conclusions

In HCV hospitals, sarcoma SCV may significantly influence RPS treatment quality. In low-volume centers surgical reports can often miss important prognostic issues and surgical quality is generally poor.