Abdominal aortic aneurysm : Fact check on volume thresholds and quality indicators

Decreasing prevalences have been reported for abdominal aortic aneurysms for many years, whereby the median case number especially for open surgical treatment of aneurysms in decentralized healthcare systems was recently still only approximately 7 per year. Against the background of the dynamic developments over more than two decades with respect to treatment procedures and medical products, the impact of the annual case volume on treatment outcomes was repeatedly controversially discussed. So far, the short-term perioperative overall mortality was predominantly available as a suitable outcome quality parameter, while many studies stem from an era where hospital mortality rates after endovascular treatment were 3 % higher than today. The current data suggest an association between case volume and outcome, particularly for open surgical procedures, while no robust effects were found for endovascular treatment with stent grafts. The heterogeneous data situation is also reflected in the current guidelines. While the North American guidelines of the Society for Vascular Surgery (SVS) recommend a procedure-specific minimum threshold of 10 procedures per year for each procedure, the European guidelines of the European Society for Vascular Surgery (ESVS) recommend a mixed minimum threshold of 20 for both procedures.