• Anna J Alberga, Gerdine C I von Meijenfeldt, Vinamr Rastogi, Jorg L de Bruin, Jan J Wever, van HerwaardenJoost AJA, Jaap F Hamming, Constantijn E V B Hazenberg, Jan van Schaik, MeesBarend M EBME, Maarten J van der Laan, Clark J Zeebregts, SchurinkGeert W HGWH, VerhagenHence J MHJM, and Dutch Society of Vascular Surgery*, the Steering Committee of the Dutch Surgical Aneurysm Audit, the Dutch Institute for Clinical Auditing.
• Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands Department of Vascular Surgery, Haga Teaching Hospital, The Hague, the Netherlands Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands.
• Ann. Surg. 2021 Dec 14.

ObjectiveWe evaluate nationwide perioperative outcomes of complex EVAR and assess the volume-outcome association of complex EVAR.Summary Of Background DataEndovascular treatment with fenestrated (FEVAR) or branched (BEVAR) endografts is progressively used for excluding complex aortic aneurysms (complex AAs). It is unclear if a volume-outcome association exists in endovascular treatment of complex AAs (complex EVAR).MethodsAll patients prospectively registered in the Dutch Surgical Aneurysm Audit who underwent complex EVAR (FEVAR or BEVAR) between January 2016 and January 2020 were included. The effect of annual hospital volume on perioperative mortality was examined using multivariable logistic regression analyses. Patients were stratified into quartiles based on annual hospital volume to determine hospital volume categories.ResultsWe included 694 patients (539 FEVAR patients, 155 BEVAR patients). Perioperative mortality following FEVAR was 4.5% and 5.2% following BEVAR. Postoperative complication rates were 30.1% and 48.7%, respectively. The first quartile hospitals performed <9 procedures/yr; second, third, and fourth quartile hospitals performed 9-12, 13-22, and ≥23 procedures/yr. The highest volume hospitals treated the significantly more complex patients. Perioperative mortality of complex EVAR was 9.1% in hospitals with a volume of < 9, and 2.5% in hospitals with a volume of ≥13 (P = 0.008). After adjustment for confounders, an annual volume of ≥13 was associated with less perioperative mortality compared to hospitals with a volume of < 9.ConclusionsData from this nationwide mandatory quality registry shows a significant effect of hospital volume on perioperative mortality following complex EVAR, with high volume complex EVAR centers demonstrating lower mortality rates.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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