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AAMC Patient Experience (HCAHPS)

AAMC Core Measure Scores

Quality measures scores on how often AAMC provides some of the recommended care compared to what other hospital average scores are across the state.


> Click here to view our core measure scores chart.

Understanding Core Measures

Abdominal Aortic Aneurysm (AAA)

An abdominal aortic aneurysm (AAA) is a weakened area that forms in the wall of the abdominal aorta - the artery that carries blood from the heart to the rest of the body. Because the aorta is the body’s largest blood vessel, a weakened area (aneurysm) may bulge out like a balloon when blood flows through it. An abdominal aortic aneurysm most often occurs below where the renal arteries branch off from the aorta to supply blood to the kidneys and above where the aorta divides into two iliac arteries, which supply blood to the pelvis and legs.

In general, the diameter of the aorta is about one inch or less. Aneurysms of less than two inches (five centimeters) rarely rupture (burst) and may pose little risk to the patient. However, aneurysms that grow larger than 5 centimeters have an increased risk of rupture and severe hemorrhage (bleeding). In most cases, physicians recommend treating aneurysms that are 5.5 centimeters or greater in diameter, or that increase in size more than a certain amount within a period of six months to one year.

About 5 percent to 7 percent of people over the age of 60 in the United States will have an abdominal aortic aneurysm. Aortic aneurysms most frequently occur in white males between the ages of 50 and 60. AAA occurs about four times more often in men than in women, and some studies have shown the rate in men to be even higher. In the past 40 years, the rate of AAA has increased greatly. The condition accounts for nearly 15,000 deaths each year, making it the 13th leading cause of death in the US.

Death due to a ruptured AAA occurs in about one in every 250 persons over the age of 50. Fortunately, early diagnosis of AAA may lead to successful treatment that prevents rupture. Treatment for AAA may require surgery, but newer techniques may not require open surgery. The specific treatment for AAA will depend on the patient’s condition and the physician’s practices.

AAA is most commonly caused by atherosclerosis (also called "hardening of the arteries"). In atherosclerosis, cholesterol and scar tissue build up gradually, forming a waxy substance called "plaque" that weakens or damages the walls of blood vessels, making them more vulnerable to an aneurysm. Other risk factors for AAA include high blood pressure, smoking and a family history of AAA. Other less common causes of aneurysms include connective tissue diseases, inflammation of the blood vessels (vasculitis), and some congenital disorders.

(Above information from The Society of Interventional Radiology.)

Abdominal Aortic Aneurysm (AAA) Quality Measures

Annual surgical volume for abdominal aortic aneurysm (AAA) repair procedures

The Leapfrog Group ( Adobe PDF PDF), a national organization devoted to improving patient safety, has suggested that a surgical program that performs at least 62 abdominal aortic aneurysm (AAA) repairs per year has better outcomes than programs performing fewer procedures.

At AAMC, 5 surgeons performed 61 AAA repair procedures in 2008.

Average length of stay for abdominal aortic aneurysm (AAA) repair

The average length of stay (measured in days) provides general information about the efficiency of care delivery, and is therefore an important quality indicator. However, patients with a greater severity of illness may have a longer average length of stay.

According to the most recent national data from the National Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ), the average length of stay for abdominal aortic aneurysm (AAA) repair was 6.77 days.

In 2009, AAMC’'s average length of stay (ALOS) for open abdominal aortic aneurysm (AAA) repair was 7.44 days, including both ruptured AAA emergency admissions and scheduled admissions. Our ALOS for endovascular AAA repair was 2.12 days.

Physician board certification

Abdominal aortic aneurysm (AAA) repair may be performed by a variety of different types of surgeons: vascular surgeons, cardiac surgeons, or general surgeons.

A board-certified physician has completed an approved educational training program and an evaluation process including an examination designed to assess the knowledge, skills and experience necessary to provide quality patient care in that specialty. A specialty certificate is issued by a medical specialty certifying board, which is valid nationwide. Although certification is not required for an individual physician to practice medicine, most hospitals and managed care organizations require that at least a certain percentage of their staff be “board certified.“ (American Board of Medical Specialties)

  • Vascular surgery
    Board certification in vascular surgery is offered by the Vascular Surgery Board of the American Board of Surgery. (American Board of Surgery)
  • General surgery
    A General Surgeon certified by the American Board of Surgery is one who has acquired during training knowledge and experience related to the diagnosis, preoperative, operative, and postoperative management, including the management of complications, in essential content areas such as the alimentary tract; the abdomen and its contents; breast, skin, and soft tissue; the endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; transplantation surgery; trauma and burns; and vascular surgery. (American Board of Surgery)

All of AAMC’s surgeons who perform AAA are board certified in their specialty.

Vascular surgeon availability for abdominal aortic aneurysm (AAA) repair

The Dartmouth Atlas of Vascular Health Care found that, in a nationwide sample of Medicare patients undergoing vascular surgery, vascular surgeons performed 39 percent of all elective (non-emergency) abdominal aortic aneurysm (AAA) repairs, versus 33 percent for cardiothoracic surgeons and 28 percent for general surgeons. Vascular surgeons as a group had a lower 30-day mortality rate than the cardiothoracic and general surgeons. In addition, as a group, vascular surgeons performed more elective AAA repairs per individual surgeon than did the other two groups. (Journal of Vascular Surgery, October 2001: 34(4); 751-756) Other studies, using patient data from Ontario, Canada and Florida, have found similar results. (Journal of Vascular Surgery, March 2001: 33(3); 447-452)

AAMC has 5 vascular surgeons on staff.

Availability of endovascular aneurysm repair (EVAR)

Since its introduction in 1991, endovascular aneurysm repair (a procedure in which a stent, or tubelike structure, is inserted into the aorta, the artery that carries blood from the heart to the rest of the body, through an incision in the groin) of abdominal aortic aneurysms (AAA) has become widely used to repair AAA.

Because the procedure is much less invasive (the incision is much smaller and less penetrating) than traditional open repair, endovascular aneurysm repair (EVAR) has been shown to have more short-term benefits, such as decreased length of hospitalization, reduced intensive care unit (ICU) stays, less blood loss, fewer major complications, and faster recovery. However, the long-term durability and effectiveness of EVAR has not been definitively proved by clinical studies.

In 2003, 40 percent of all elective AAA repairs were endovascular, according to an article in Vascular Disease Management (December 2005; 2(6): 165-167). However, due to differences in anatomy, fewer women are candidates for EVAR.

Recent studies indicate that the one-year survival rate after EVAR is not as high as that for the traditional open repair method of AAA surgery (The New England Journal of Medicine, June 2005; 352(23): 2398-2405). EVAR remains a viable surgical option for AAA repair and has fewer short-term risks, such as excessive blood loss and the need for transfusion than open AAA repair.

To determine if EVAR is an option for you, check with your physician.

Endovascular aneurysm repair is available at AAMC.

Inpatient mortality rate for AAA repair

The mortality rate (measured as a percentage) provides general information about the quality of care delivery, and can be an important quality indicator. However, some hospitals care for patients with a greater severity of illness and therefore may have a higher mortality rate.

According to the most recent national data available from the Healthcare Cost and Utilization Project’s (HCUP) Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality (AHRQ), the inpatient mortality rate for abdominal aortic aneurysm (AAA) was 6.7 percent. (HCUP).

The inpatient mortality rate for AAA repair at AAMC was 2.0 percent in 2009.