Department of Surgery, Liverpool Hospital, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia.
Department of Surgery, Liverpool Hospital, Sydney, Australia.
J Vasc Surg. 2021 Jul;74(1):287-295. doi: 10.1016/j.jvs.2020.12.104. Epub 2021 Feb 4.
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.
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.
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.
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.
血管内动脉瘤修复术（EVAR）在大都市和地区医院的血管外科中越来越成为主流。本综述旨在评估医院和外科医生数量对这种手术类型的围手术期死亡率的影响，以支持广泛使用这种治疗方式。
使用详细的搜索策略，在多个专门的医学数据库上进行了文献搜索，重点关注医院数量和 EVAR。使用纳入和排除标准筛选和评估合适的来源，重点关注进行 EVAR 的操作人员和医院以及发病率/死亡率等结果。然后使用 PRISMA 框架评估结果。
我们回顾了 45 篇文章。有 12 篇文章符合完整审查的纳入标准。没有一级证据，只有一篇系统评价和荟萃分析。EVAR 和胸主动脉 EVAR 的围手术期死亡率与医院数量无关。有限的证据表明，基于医院数量的血管腔内治疗风险仍然没有答案。用于动脉瘤修复的开放手术的围手术期死亡率结果与医院数量明显相关，支持在高容量中心使用这些手术。
由于开放动脉瘤修复术在低容量中心的死亡率风险增加，而血管内治疗选择正在获得动力，因此在较小的地区中心安全有效地使用 EVAR 和胸主动脉 EVAR 具有相当大的支持。在使用开窗 EVAR 方面证据非常有限，仍未得到解答，但为研究提供了重要机会。
