Objective: To assess the relationship between the annual caseload of elective open abdominal aortic aneurysm (AAA) repairs performed by individual surgeons and mortality.
Methods: PubMed, EMBASE, and the Cochrane library were searched for articles on the volume-outcome relationship in AAA surgery. The review conformed to the QUOROM statement. The data were meta-analyzed to compare the mortality rates of higher- and lower-volume surgeons. A critical volume threshold was calculated for better practice.
Results: Fourteen relevant articles were retrieved from the searches. A systematic review was performed, and six were meta-analyzed. A total of 115,273 elective open AAA repairs were considered, with a mean mortality rate of 5.56%. Significant relationships between higher surgeon caseload and lower mortality were demonstrated in 12 of 14 studies. From the meta-analysis, the pooled effect estimate was an odds ratio of 0.56 (95% confidence interval, 0.54-0.57) in favor of higher-volume surgeons. A critical volume threshold was identified as 13 cases per annum for individual surgeons.
Conclusions: As surgeons performed higher annual volumes of elective open AAA repairs, significantly lower mortality rates were demonstrated. Surgeons wishing to perform elective AAA repairs should achieve a minimum case volume of 13 repairs per annum.