Thoracic endovascular aortic repair (TEVAR) procedures performed at low-volume hospitals (LVH) are not associated with worse outcomes than those performed at high-volume hospitals (HVH), according to a new study published in the Journal of Vascular Surgery.
“Since surgical mortality associated with many procedures has significantly declined with advances in technologies, surgical techniques, anesthesia and critical care, the relative importance of the hospital volume of selected procedures may be falling,” wrote lead author Noora Alhajri MD, MPH, a specialist at Khalifa University in the United Arab Emirates, and colleagues. “TEVAR has become the treatment of choice for variety of thoracic aortic pathologies and has been shown to have lower operative mortality rates, length of stay and lower overall complication rates, when compared to open surgery. The association between TEVAR outcomes and hospital volume is unclear.”
Alhajri et al. explored the Society for Vascular Surgery Vascular Quality Initiative database, focusing on more than 3,500 TEVAR patients treated from January 2015 to December 2019. All patients received care in the United States or Canada. While 55.7% of patients were treated in a LVH, the remaining 44.3% were treated in an HVH.
While the median number of asymptomatic TEVAR cases treated per year at a LVH was 6.2, the median number at a HVH was 16.6. Looking at symptomatic cases or patients with a rupture aneurysm, meanwhile, the median number of cases pear year at a LVH was 6.2, and the median number at an HVH was 17.2.
Overall, there was “no significant difference” in 30-day mortality among patients treated at LVH and HVH. Treatment at a LVH was also not associated with an increased risk of major complications.
The group noted that TEVAR “does not require a complex set of skills to perform.”
“Most vascular surgeons who are experienced in endovascular procedures can safely preform this procedure,” the authors wrote. “Our results suggest that TEVAR could be safely preformed across a wide range of hospitals regardless of their volume status, without any complex regionalization health policies that could be disruptive to both patient and healthcare system, and without mobilizing the patient further from their local support environment. This observation suggests that in contrast to complex open vascular procedures, the increasing using of TEVAR, especially in local or community hospitals, could be a way to minimize volume-outcome disparities.”
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.