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QUESTION: In patients having 1 of 8 common surgical procedures of intermediate complexity in Veterans Health Administration (VHA) hospitals, is surgical volume related to 30 day mortality and stroke?
6 year cohort study using the database of the Veterans Affairs (VA) National Surgical Quality Improvement Program.
125 VA medical centres in the United States.
68 631 patients (mean age 64 y, 97% men, 78% white) who were having 1 of 8 major surgical procedures: non-ruptured abdominal aortic aneurysm repair, vascular infrainguinal reconstruction, carotid endarterectomy (CEA), lung lobectomy or pneumonectomy, open cholecystectomy, laparoscopic cholecystectomy, colectomy, and total hip arthroplasty.
Assessment of risk factors
Preoperative risk factors that are predictive of 30 day mortality were identified in logistic regression models constructed for each operation. An additional model was constructed to identify risk factors predictive of stroke within 30 days of CEA.
Main outcome measures
30 day mortality for all procedures and stroke within 30 …
Source of funding: Veterans Health Administration of the Department of Veterans Affairs, USA.
For correspondence: Dr SF Khuri, Veterans Affairs Medical Center, 1400 VFW Parkway, West Roxbury, MA 02132, USA. Fax +1 617 363 5567.