Surgeon involvement in defining criteria to determine safe surgery.

In the article by Mehta et al, 1 Mehta A. Patel P. Elmously A. et al. Low-volume surgeons can have better outcomes at certain hospital settings for open abdominal aortic repairs. J Vasc Surg. 2023; 78: 638-646 Abstract Full Text Full Text PDF Scopus (1) Google Scholar the authors used the Vascular Quality Initiative registry to analyze outcomes of aortic surgeries through a 7-year period at a large number of facilities of varied sizes and types. The authors sought to determine whether low-volume surgeons’ (<7 open aortic surgeries annually) outcomes were impacted by hospital characteristics where these procedures were performed, hypothesizing that hospital characteristics would have an effect. The authors used 30-day mortality, major postoperative complications, and failure-to-rescue as primary outcomes and included all open aortic surgeries for volume purposes but only elective surgeries for outcome analyses. Surgeons and hospitals were categorized based upon Leapfrog criteria. 2 Group T.L. Safety in numbers: hospital performance on Leapfrog’s Surgical volume Standard based on results of the 2019 Leapfrog hospital Survey. 2020https://www.leapfroggroup.org/sites/default/files/Files/Leapfrog%20Report%20on%20Sa20fe%20Surgical%20Volumes%202020.pdfDate accessed: May 29, 2023 Google Scholar The authors noted that low-volume surgeons operating at high-volume hospitals had lower rates of perioperative death and failure-to-rescue but similar rates of complications. It is important to recognize that during this time period, 73% of patients had surgery performed by “low-volume” surgeons, whereas of these, over two-thirds had their surgery at a high-volume center. Outcomes for aneurysm surgery appear to reflect more upon the center than the surgeon. In fact, even when a low-volume surgeon performs aneurysm surgery at a center where there is a single high-volume surgeon, mortality is improved. As we move into an era where hospitals are assessed regarding their ability to perform specific vascular operations based on criteria developed by organizations, it is increasingly important for vascular surgeons to be “at the table” helping to define these criteria. Similarly, as these entities such as Leapfrog, ProPublica, and others seek to inform the public regarding what defines safety for complex operations, it is imperative that vascular surgeons seek to lead in determining what “defines” safety for patients receiving care from vascular surgeons. It is heartening that the conclusions of the authors support Society for Vascular Surgery guidelines regarding the number of aortic procedures regarded as a minimum for performing open aortic surgery, 3 Chaikof E.L. Dalman R.L. Eskandari M.K. et al. The Society for Vascular Surgery practice guidelines on the case of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018; 67: 2-77.e2 Abstract Full Text Full Text PDF PubMed Scopus (1418) Google Scholar but it is clear that better understanding regarding safety indicators for facilities and surgeons is needed. As a specialty, we must lead in transparency regarding outcomes and in assuring that patients undergoing complex vascular operations have the safest outcomes possible. Congratulations to these authors on their work to better understand how surgeon and hospital characteristics impact aortic surgery outcomes. Understanding these factors is the only way to lead change that can improve outcomes for our patients undergoing aortic surgery. Low-volume surgeons can have better outcomes at certain hospital settings for open abdominal aortic repairsJournal of Vascular SurgeryVol. 78Issue 3PreviewThe volume-outcomes relationship is cross-cutting among open abdominal aortic operations, where higher-volume surgeons have better perioperative outcomes. However, there has been minimal focus on low-volume surgeons and how to improve their outcomes. This study sought to identify if there are any differences in outcomes among low-volume surgeons for open abdominal aortic surgeries by different hospital settings. Full-Text PDF