The influence of surgical specialty training on the outcomes of elective abdominal aortic aneurysm surgery

Objective — The aim of this study was to determine the independent impact of surgeon speciality training (vascular, cardiac, or general surgery) on the 30-day risk-adjusted mortality rate after elective abdominal aortic aneurysm (AAA) surgery.

Patients and Methods — All patients undergoing elective AAA surgery in Ontario between April 1, 1992, and March 31, 1996, were included. A retrospective cohort study with linked administrative databases was undertaken.

Results — The average 30-day mortality rate was 4.1%. Of the 5878 cases studied, 4415 (75.1%) were performed by 63 vascular surgeons, 1193 (20.3%) by 53 general surgeons, and 270 (4.6%) by 14 cardiac surgeons. After the adjustment for potential confounding factors of annual surgeon AAA volume, type of hospital, and patient age, sex, Charlson comorbidity score, and transfer status, the odds of patients dying were 62% higher when the surgery was performed by a general surgeon than when it was performed by a vascular surgeon. Cardiac surgeons' patient outcomes were similar to those of vascular surgeons.

Conclusions — Patients who undergo elective AAA repair that is performed by vascular or cardiac surgeons have significantly lower mortality rates than patients who have their aneurysms repaired by general surgeons. These results provide evidence that surgical specialty training in vascular procedures leads to better patient outcomes.