Debate: Whether abdominal aortic aneurysm surgery should be centralized at higher-volume centers

Volume-outcome relationships in vascular surgery have become increasingly relevant in recent years. At the individual surgeon level, increased experience has been linked with improved patient outcomes after volume-outcome and learning curve analyses. At the hospital level, further analyses have generally shown a similar relationship linking the busier hospitals with improved outcomes. However, is this relationship sufficient and robust enough to support important health care delivery decisions regarding centralization of care? In England, such information has helped to shape the vascular surgery reorganization process in London. The following discussion presents the advantages and disadvantages of the practical use of such information.