{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:15:04Z","timestamp":1785402904165,"version":"3.56.0"},"reference-count":13,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Centralisation of open abdominal aortic aneurysm (AAA) repair is widely advocated, but supporting evidence often conflates institutional volume with individual surgeon expertise. We report outcomes of open AAA repair at a small- to medium-volume centre and assess the contributions of surgeon experience, multidisciplinary perioperative care, and supervised surgical teaching. Methods: Retrospective analysis of all consecutive patients undergoing open AAA repair between January 2017 and December 2023. Endovascular procedures were excluded. The primary endpoint was 30-day all-cause mortality. Secondary endpoints included perioperative morbidity, acute kidney injury (AKI), length of stay, and overall survival. Results: A total of 195 patients underwent open AAA repair (162 elective; 33 urgent\/emergency), with a mean of 27.9 cases annually. Mean age was 70.2 years (SD 8.1), and 85.6% were male. Thirty-day mortality was 1.5% overall (3\/195) and 1.2% (2\/162) for elective cases, with no significant difference between elective and urgent\/emergency cases (1.2% vs. 3.0%; p = 0.430). No perioperative strokes occurred; myocardial infarction occurred in three patients (1.5%). Median operative time was 261 min (IQR 210\u2013320), reflecting systematic supervised teaching in approximately 95% of cases. AKI occurred in 10.3%; clinically significant renal insufficiency at 30 days occurred in 5.1%, and no patient required permanent renal replacement therapy. The perioperative reintervention rate was 9.2%, and median hospital stay was 8 days (IQR 7\u201312). At a mean follow-up of 62.3 months (SD 25.1), overall mortality was 7.7% and aneurysm-related mortality 1.0%. Kaplan\u2013Meier estimated overall survival was 98.5%, 95.8%, and 89.0% at 1, 3, and 7 years, respectively. Conclusions: Favourable outcomes can be achieved at small- to medium-volume centres through concentrated surgeon expertise, structured teaching, and a high-functioning multidisciplinary team. These findings support a more nuanced assessment of open AAA repair that considers surgeon experience, team performance, and demonstrated outcomes rather than institutional volume alone.<\/jats:p>","DOI":"10.3390\/jcm15155939","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T08:09:42Z","timestamp":1785398982000},"page":"5939","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Volume Metrics: Outcomes of Open Abdominal Aortic Aneurysm Repair in a Small-to-Medium Volume Hospital\u2014Challenging the Centralization Paradigm: A Single-Centre Retrospective Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9247-8818","authenticated-orcid":false,"given":"Alessandro","family":"Robaldo","sequence":"first","affiliation":[{"name":"Division of Vascular Surgery and Angiology, Centro Vascolare Ticino, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1232-7003","authenticated-orcid":false,"given":"Pietro Federico","family":"Ricciardi","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Angiology, Centro Vascolare Ticino, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"},{"name":"Vascular Surgery Unit, Heart and Vessel Department, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4987-0262","authenticated-orcid":false,"given":"Luca","family":"Giovannacci","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Angiology, Centro Vascolare Ticino, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7812-8688","authenticated-orcid":false,"given":"Alexandre","family":"Azoulay","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Angiology, Centro Vascolare Ticino, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"},{"name":"Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, 34090 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Garbero","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Angiology, Centro Vascolare Ticino, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovica","family":"Ettorre","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Angiology, Centro Vascolare Ticino, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Galafassi","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Angiology, Centro Vascolare Ticino, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2366-6473","authenticated-orcid":false,"given":"Matteo","family":"Bernasconi","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Angiology, Centro Vascolare Ticino, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7947-3473","authenticated-orcid":false,"given":"Giorgio","family":"Prouse","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Angiology, Centro Vascolare Ticino, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.ejvs.2023.11.002","article-title":"Editor\u2019s Choice\u2014European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms","volume":"67","author":"Wanhainen","year":"2024","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.jvs.2017.10.044","article-title":"The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm","volume":"67","author":"Chaikof","year":"2018","journal-title":"J. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1097\/SLA.0b013e31826b4f91","article-title":"Changes in abdominal aortic aneurysm rupture and short-term mortality, 1995\u20132008: A retrospective observational study","volume":"256","author":"Schermerhorn","year":"2012","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.ejvs.2017.11.016","article-title":"Editor\u2019s Choice\u2014High annual hospital volume is associated with decreased in-hospital mortality and complication rates following treatment of abdominal aortic aneurysms: Secondary data analysis of the nationwide German DRG statistics from 2005 to 2013","volume":"55","author":"Trenner","year":"2018","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1002\/bjs.5710","article-title":"Meta-analysis and systematic review of the relationship between volume and outcome in abdominal aortic aneurysm surgery","volume":"94","author":"Holt","year":"2007","journal-title":"Br. J. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1002\/bjs.8696","article-title":"Provider volume and long-term outcome after elective abdominal aortic aneurysm repair","volume":"99","author":"Holt","year":"2012","journal-title":"Br. J. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1016\/j.jvs.2020.07.108","article-title":"Association and interplay of surgeon and hospital volume with mortality after open abdominal aortic aneurysm repair in the modern era","volume":"73","author":"Sharma","year":"2021","journal-title":"J. Vasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1016\/j.jvs.2011.05.103","article-title":"Defining the type of surgeon volume that influences the outcomes for open abdominal aortic aneurysm repair","volume":"54","author":"Modrall","year":"2011","journal-title":"J. Vasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.ejvs.2023.03.037","article-title":"Impact of Multidisciplinary Team Meetings on Decision Making in Vascular Surgery: A Prospective Observational Study","volume":"66","author":"Prouse","year":"2023","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jvs.2015.07.071","article-title":"The effect of trainee involvement on perioperative outcomes of abdominal aortic aneurysm repair","volume":"63","author":"DiDato","year":"2016","journal-title":"J. Vasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.jvs.2007.10.001","article-title":"Colon ischemia following abdominal aortic aneurysm repair in the era of endovascular abdominal aortic repair","volume":"47","author":"Becquemin","year":"2008","journal-title":"J. Vasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1056\/NEJMsa1300625","article-title":"Surgical skill and complication rates after bariatric surgery","volume":"369","author":"Birkmeyer","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Loschi, D., Rinaldi, E., Santoro, A., Favia, N., Galati, N., and Melissano, G. (2024). A Systematic Review of Renal Perfusion in Complex Abdominal Aortic Aneurysm Open Repair. J. Cardiovasc. Dev. Dis., 11.","DOI":"10.3390\/jcdd11110341"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5939\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T08:39:32Z","timestamp":1785400772000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5939"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":13,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15155939"],"URL":"https:\/\/doi.org\/10.3390\/jcm15155939","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]}}}