Articles: hospital-volume.
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Multicenter Study Observational Study
Association and interplay of surgeon and hospital volume with mortality after open abdominal aortic aneurysm repair in the modern era.
Operative volume has been used as a marker of quality. Research from previous decades has suggested minimum open abdominal aortic aneurysm (AAA) repair volume requirements for surgeons of 9 to 13 open AAA repairs annually and for hospitals of 18 open AAA repairs annually to purportedly achieve acceptable results. Given concerns regarding the decreased frequency of open repairs in the endovascular era, we examined the association of surgeon and hospital volume with the 30- and 90-day mortality in the Vascular Quality Initiative (VQI) registry. ⋯ Surgeons and hospitals in the VQI registry achieved mortality outcomes of <5% (Society for Vascular Surgery guidelines), with an average surgeon volume that was substantially lower compared with previous reports. Furthermore, when considering the development of minimal surgeon volume guidelines, it is important to contextualize the outcomes within the hospital volumes.
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Emergency general surgery (EGS) contributes to half of all surgical mortality nationwide, is associated with a 50% complication rate, and has a 15% readmission rate within 30 days. We assessed associations between surgeon and hospital EGS volume with these outcomes. ⋯ We found evidence that surgeon EGS volume was associated with outcomes. Developing EGS-specific services, mentorship opportunities, and clinical pathways for less-experienced surgeons may improve outcomes.
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The purpose of this study was to investigate the impact of hospital volume on perioperative outcomes of clinical tumour stage (cT)1-3 and cT4 rectal cancer. ⋯ For cT4 rectal cancer, high volume hospitals may offer a better multimodality treatment, while for cT1-3 rectal cancer there appears no benefit for centralization.