The Impact of Hospital Volume on the Development of Infectious Complications After Elective Abdominal Aortic Surgery in the Medicare Population

The objective of the current study was to determine the effect of hospital volume on outcomes of abdominal aortic surgery for patients older than and younger than 65 years. In order to perform this investigation, information on all adult patients who underwent abdominal aortic surgery in Maryland from 1994 to 1996 ( N = 2,987 patients) in 45 acute care hospitals was obtained. Hospitals were designated as low (< 20/year), medium (20 to 36/year), or high (> 36/year) volume according to the annual number of procedures performed. The relationship of hospital volume and mortality was determined for patients less than or greater than 65 years old. Two separate multiple logistic regression models were used to adjust for patient case-mix in each age category. Of the 2,987 patients, 2,067 (69%) were older than 65 years and 920 (31%) were younger. The crude in-hospital mortality rates according to hospital volume were 2.7% (low), 2.1% (medium), and 2.7% (high) for patients younger than 65 years old ( p = .8). For patients older than 65 years, in-hospital mortality rates were 11.9% (low), 9.9% (medium), and 6.9% (high) ( p = .005). After adjusting for patient case-mix in a multivariate analysis, high hospital volume was associated with a decreased risk of in-hospital mortality for patients older than 65 years (OR 0.57; 95% CI 0.37 to 0.86; p = .008) but not for patients under 65 years old. In conclusion, hospital volume was associated with decreased in-hospital mortality after abdominal aortic surgery only for patients greater than 65 years old. Because of this differential effect, targeting elderly patients for regionalization would achieve most potentially avoidable deaths for this common high-risk surgical procedure.

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Composite Quality Measures for Abdominal Aortic Surgery: Moving Beyond Hospital Volume

Journal of Surgical Research ◽

10.1016/j.jss.2009.11.395 ◽

2010 ◽

Vol 158 (2) ◽

pp. 312-313

Author(s):

N.H. Osborne ◽

J.D. Birkmeyer ◽

J.B. Dimick

Keyword(s):

Hospital Volume ◽

Aortic Surgery ◽

Quality Measures ◽

Abdominal Aortic Surgery ◽

Abdominal Aortic

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Continuous Elastomeric Pump-Based Ropivacaine Wound Instillation after Open Abdominal Aortic Surgery: How Reliable Is the Technique?

The Heart Surgery Forum ◽

10.1532/hsf98.20101089 ◽

2011 ◽

Vol 14 (1) ◽

pp. 51 ◽

Cited By ~ 3

Author(s):

Werner Baulig ◽

Konrad Maurer ◽

Oliver Michel Theusinger ◽

Valentin Hinselmann ◽

Barbara Baulig ◽

...

Keyword(s):

Postoperative Pain ◽

Rating Scale ◽

Aortic Surgery ◽

Plasma Concentrations ◽

Control Group ◽

Abdominal Aortic Surgery ◽

Abdominal Aortic ◽

Morphine Administration ◽

Surgical Data ◽

The Impact

Introduction: We aimed at quantifying the impact of continuous wound infusion with ropivacaine 0.33% on morphine administration and subjective pain relief in patients after open abdominal aortic repair in a double-blind, placebo-controlled study.Methods: Before closing the abdominal wound, 2 multihole ON-Q Soaker Catheters (I-Flow Corporation, Lake Forest, California, USA) were placed pre-peritoneally in opposite directions. Either ropivacaine 0.33% or saline 0.9% was delivered by an elastomeric pump at a rate of 2 mL/h for 72 hours in each of the catheters. Postoperative pain and morphine administration were assessed using the numerical rating scale (NRS) in 4-hour intervals. Total plasma concentrations of ropivacaine, unbound ropivacaine, and 1-acid glycoprotein (AAG) were measured daily. Mean arterial pressure, pulse rate, oxygen saturation, total amount of morphine administration, ventilation time, and length of stay in the intensive care unit (ICU) were recorded. At the end of the study period, the wound site and the condition of the catheters were assessed.Results: The study was terminated prematurely due to a malfunction of the elastomeric balloon pump resulting in toxic serum levels of total ropivacaine in 2 patients (11.4 mol/L and 10.0 mol/L, respectively) on the second postoperative day. Six patients had been allocated to the ropivacaine group, and 9 patients had been allocated to the control group. Demographic and surgical data were similar in both groups. During the first 3 postoperative days, no difference between the ropivacaine and the control group was found in NRS (P = .15, P = .46, and P = .88, respectively) and morphine administration (P = .48). Concentrations of unbound serum ropivacaine (0.11 0.08 mol/L) were below toxic level in all patients.Conclusion: Continuous wound infusion of ropivacaine 0.33% 2 mL/h using an elastomeric system was not reliable and did not improve postoperative pain control in patients after open abdominal aortic surgery.

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