Evidence map›Paper›PMID 34536499›Full record

Observational studyJournal of vascular surgery2022

Reliability of hospital-level mortality in abdominal aortic aneurysm repair.

Craig S Brown, John R Montgomery, Gloria Y Kim, Michael T Kemp, Nicholas H Osborne

Abstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of vascular surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Craig S BrownSection of General Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Mich. Electronic address: brcraig@med.umich.edu.
John R MontgomerySection of General Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Mich.
Gloria Y KimCenter for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Mich; Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich.
Michael T KempSection of General Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich.
Nicholas H OsborneCenter for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Mich; Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich.

Funding

Understanding Real-World Outcomes of Endovascular Treatment of ClaudicationK08HL144924 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI OSBORNE, NICHOLAS HAROLD · 2019 to 2023
$848k
Characterizing and Reducing New Persistent Opioid Use in Patients Undergoing Complex Major SurgeryF32DA050416 · NIDA · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI BROWN, CRAIG · 2020 to 2020
$74k
NHLBI NIH HHS K08 HL144924NIDA NIH HHS F32 DA050416
6 · The paper itself

Abstract

objectiveThe relationship between volume and surgical outcomes has been shown for a variety of surgical procedures. The effects in abdominal aortic aneurysm repair have continued to be debated. Reliability adjustment has been used as a method to remove statistical noise from hospital-level outcomes. However, its impact on aortic aneurysm repair is not well understood.

methodsWe used prospectively collected data from the Vascular Quality Initiative to identify all patients who had undergone abdominal aortic aneurysm repair from 2003 to 2019. We first calculated the hospital-level risk-adjusted 30-day mortality rates. We subsequently used hierarchical logistic regression modeling to adjust for measurement reliability using empirical Bayes techniques. The effect of volume on risk- and reliability-adjusted mortality rates was then assessed using linear regression.

resultsBetween 2003 and 2019, 67,073 abdominal aortic aneurysms were repaired, of which 11,601 (17.3%) were repaired with an open approach. The median annual volume was 7.4 (interquartile range, 3.0-13.3) for open repairs and 35.4 (interquartile range, 18.8-59.8) for endovascular repairs. Of the 223 hospitals that had performed open repairs during the study period, only 11 (4.9%) had performed ≥15 open repairs annually, and the risk-adjusted mortality rates varied from 0% to 75% across all centers. After reliability adjustment, the variability of the risk-adjusted mortality rates had decreased significantly to 1.3% to 8.2%. The endovascular repair risk-adjusted mortality rate variability had decreased from 0% to 14.3% to 0.3% to 2.8% after reliability adjustment. A decreasing trend in mortality was found with increasing an annual case volume for open repair with each additional annual case associated with a 0.012% decrease in mortality (P = .05); however, the relationship was not significant for endovascular repair (P = .793).

conclusionsWe found that most hospitals do not perform a sufficient number of annual cases to generate a reliable center-specific mortality rate for open aneurysm repair. Center-specific mortality rates for low-volume centers should be viewed with caution, because a substantial proportion of the variation for these outcomes will be statistical noise rather than true center-level differences in the quality of care.

Indexed as

AgedAortic Aneurysm, AbdominalBlood Vessel Prosthesis ImplantationElective Surgical ProceduresFemaleHospital MortalityHumansIncidenceMalePostoperative ComplicationsReproducibility of ResultsRisk AssessmentRisk FactorsSurvival RateTime FactorsUnited StatesAortic aneurysmMortalityReliability

Identifiers

PMID34536499
PMCPMC8792170

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.