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Home > Press Center > Press Releases from 2007 Annual Meeting > Surgeon Experience Predicts Success of Aneurysm Repair

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Emily Kalata
Assistant Director, Communications
312.334.2309

Researchers from the Vascular Surgery Division of New York-Presbyterian Hospital System and the International for Health Outcomes and Innovated Research (InChoir) at Columbia University, both in New York City, have completed a study as to whether mortality and adverse events are predicted by a surgeon’s experience in endovascular repair of abdominal aortic aneurysms. They also evaluated the minimum experience needed for proficiency. Their findings were presented today at the 61st Annual Meeting of the Society for Vascular Surgery. 

James F. McKinsey, MD, site chief of the New York-Presbyterian Hospital Division of Vascular Surgery for the Columbia University Medical Center Campus, noted that although the use of EVAR technique (which was introduced in 2000) has markedly increased, there is little research about the relationship between physician experience in EVAR and clinical outcomes.

“Our data from the 2002-2004 National Medicare Database showed that minimum level for less experienced surgeons performing EVAR is less than 10 procedures,” said McKinsey. “About one-third of patients are being treated by less experienced surgeons and there are higher procedure-related complications and mortality, when controlling comorbidities. Likewise bleeding, respiratory, cardiac complications and urgent conversions to open repair were higher for the inexperienced surgeons. Therefore guidelines for surgical accreditation need to be set.”

A total of 39,815 EVAR procedures were performed by 4,339 physicians from 2000-2004. The number of procedures by less experienced surgeons decreased from 64 percent in 2001 to 30 percent in 2003. However, between 2003 and 2004 the total number of procedures reached a plateau at 3,500 per year, while EVARs performed by high experienced surgeons (with more than 50 procedures) only increased from 3 to 23 percent.

We identified patients with the ICD-9 procedure code 38.44 for EVAR and specific operating physician codes. Patient demographics, comorbidities, perioperative complications and 30-days mortality were evaluated. Multivariable logistic regression models, student t-tests and chi-square analyses were used.

There was no significant difference in the age, gender, race and ethnicity for patients between the low-and high-experienced surgeons. The EVARs performed by low experienced surgeons had a significantly higher 30-day mortality of 2.11 percent, whereas the mortality was in the range of 1.4 to 1.6 percent for surgeons with a cumulative experience of more than 10 procedures.