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 aneury sm (AAA) surgery. Patients and Methods: All patients undergoing elective AAA surgery in Ontar io between April 1, 1992, and March 31, 1996, were included. A retrospectiv e cohort study with linked administrative databases was undertaken. Results: The average 30-day mortality rate was 4.1%. Of the 5878 cases stud ied, 4415 (75.1%) were performed by 63 vascular surgeons, 1193 (20.3%) by 5 3 general surgeons, and 270 (4.6%) by 14 cardiac surgeons. After the adjust ment for potential confounding factors of annual surgeon AAA volume, type o f hospital, and patient age, sex, Charlson comorbidity score, and transfer status, the odds Of patients dying were 62% higher when the surgery was per formed by a general surgeon than when it was performed by a vascular surgeo n. Cardiac surgeons' patient outcomes were similar to those of vascular sur geons. Conclusions Patients who undergo elective AAA repair that is performed by v ascular or cardiac surgeons have significantly lower mortality rates than p atients who have their aneurysms repaired by general surgeons. These result s provide evidence that surgical specialty training in vascular procedures leads to better patient outcomes.