Trends and Outcomes of Elective Abdominal Aortic Aneurysm Repair in California State 2016 to 2022

Contemporary elective EVAR in California demonstrates uniformly low mortality with few outliers and no hospital-volume threshold. The OSR outcomes are more variable, yet hospital volume is not associated with mortality. These findings support broad access to EVAR with routine outcomes-based surveillance and suggest that any concentration of open repair should be guided by demonstrated outcomes rather than arbitrary minimum-volume mandates.Clinical ImpactThis study provides actionable guidance for service design and referral. Elective endovascular aneurysm repair (EVAR) shows uniformly low mortality across hospitals, so access can remain broad; quality efforts should focus on continuous audit and rapid remediation of the rare high-mortality outliers identified by funnel monitoring. Open repair exhibits wider variability without a defensible volume cutoff; therefore, complex or open-eligible cases should be preferentially directed to teams with demonstrated outcomes rather than to centers meeting arbitrary case counts. Programs should formalize escalation and transfer pathways for open repair, maintain surgeon competence through targeted case concentration and cross-site coverage, and track outcomes with risk-adjusted dashboards. For patients, counseling can emphasize excellent early safety with EVAR and selective use of open surgery in experienced hands. Health systems can allocate resources toward EVAR capacity, surveillance infrastructure, and preservation of open aortic expertise instead of enforcing rigid volume minimums.