Hospital size and type affect mortality following OAR and EVAR

Factors in hospitals such as their size and type affect mortality after patients undergo open abdominal aortic aneurysm repair (OAR) or endovascular abdominal aortic aneurysm repair (EVAR), according to a database analysis.

The 30-day mortality for OAR increased significantly as hospital size decreased, while there was no significant association between mortality and hospital size for EVAR.

In addition, 30-day mortality for EVAR was significantly lower at academic hospitals compared with community hospitals, while the hospital type had no effect on mortality in patients undergoing OAR.

Lead researcher Mahmoud B. Malas, MD, MHS, of Johns Hopkins Bayview Medical Center in Baltimore, and colleagues published their findings online in JAMA Surgery on May 13.

They gathered information from the American College of Surgeons National Surgical Quality Improvement Program database on patients undergoing elective infrarenal OAR or EVAR between July 1, 2010 and Nov. 30, 2012.

Of the 11,250 patients in this analysis, 21.9 percent underwent OAR and 78.1 percent underwent EVAR. EVAR was more common at academic and community hospitals.

Researchers wrote that the 30-day mortality rates for both procedures were higher than they expected. The 30-day mortality for OAR was 14 percent overall, 13.5 percent at academic hospitals and 14.9 percent at community hospitals. For EVAR, 30-day mortality was 4.3 percent overall, 2.6 percent at academic hospitals and 11.2 percent at community hospitals.

Based on a multivariable analysis, researchers found academic hospitals were the most significant predictors of reduced mortality.

They suggested establishing regional centers of excellence for OAR and EVAR, where doctors could monitor postoperative care and possibly improve mortality rates.