Single versus multi-specialty operative teams: association with perioperative mortality after endovascular abdominal aortic aneurysm repair.
Academic Article
Overview
abstract
Endovascular abdominal aortic aneurysm repair (EVAR) requires both endovascular and open surgical skills. Although usually performed by a single operating specialist, EVAR may alternatively involve multiple teams from different specialties performing separate procedural components. We examined the relative frequencies of single versus multi-specialty EVAR in the 2005 to 2008 American College of Surgeons National Surgical Quality Improvement Participant Use Datafile and explored the influence of multi-specialty EVAR on 30-day mortality. EVARs were identified and classified as single or multiple-specialty procedures based on Current Procedural Terminology codes. Baseline and procedural characteristics were compared using χ(2) or Fisher's exact test for categorical variables and t test for continuous variables. The association between multi-specialty EVAR and 30-day mortality was examined using a multivariate logistic regression model. Of 7269 EVAR patients identified, 7086 were single and 183 were multi-specialty. Multi-specialty patients had higher frequency of brachial or iliac artery exposure and longer operative times, but were otherwise similar in baseline and procedural characteristics. In the multivariate model, multi-specialty EVAR was associated with increased risk of 30-day mortality (odds ratio 2.35; 95% confidence interval 1.08-5.11; P value 0.031). Multi-specialty participation in EVAR procedures is associated with significantly higher 30-day mortality. Further research is warranted to determine whether multi-specialty participation reflects provider experience, institutional protocols, procedural complexity, non-surgical or other factors.
