Early Indicators of the Impact of Using AI in Mammography Screening for Breast Cancer.

Background Retrospective studies have suggested that using artificial intelligence (AI) may decrease the workload of radiologists while preserving mammography screening performance. Purpose To compare workload and screening performance for two cohorts of women who underwent screening before and after AI system implementation. Materials and Methods This retrospective study included 50-69-year-old women who underwent biennial mammography screening in the Capital Region of Denmark. Before AI system implementation (October 1, 2020, to November 17, 2021), all screenings involved double reading. For screenings conducted after AI system implementation (November 18, 2021, to October 17, 2022), likely normal screenings (AI examination score ≤5 before May 3, 2022, or ≤7 on or after May 3, 2022) were single read by one of 19 senior full-time breast radiologists. The remaining screenings were read by two radiologists with AI-assisted decision support. Biopsy and surgical outcomes were retrieved between October 1, 2020, and April 15, 2023, ensuring at least 180 days of follow-up. Screening metrics were compared using the χ2 test. Reading workload reduction was measured as saved screening reads. Results In total, 60 751 and 58 246 women were screened before and after AI system implementation, respectively (median age, 58 years [IQR, 54-64 years] for both cohorts), with a median screening interval before AI of 845 days (IQR, 820-878 days) and with AI of 993 days (IQR, 968-1013 days; P < .001). After AI system implementation, the recall rate decreased by 20.5% (3.09% before AI [1875 of 60 751] vs 2.46% with AI [1430 of 58 246]; P < .001), the cancer detection rate increased (0.70% [423 of 60 751] vs 0.82% [480 of 58 246]; P = .01), the false-positive rate decreased (2.39% [1452 of 60 751] vs 1.63% [950 of 58 246]; P < .001), the positive predictive value increased (22.6% [423 of 1875] vs 33.6% [480 of 1430]; P < .001), the rate of small cancers (≤1 cm) increased (36.6% [127 of 347] vs 44.9% [164 of 365]; P = .02), the rate of node-negative cancers was unchanged (76.7% [253 of 330] vs 77.8% [273 of 351]; P = .73), and the rate of invasive cancers decreased (84.9% [359 of 423] vs 79.6% [382 of 480]; P = .04). The reading workload was reduced by 33.5% (38 977 of 116 492 reads). Conclusion In a population-based mammography screening program, using AI reduced the overall workload of breast radiologists while improving screening performance. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Lee and Friedewald in this issue.

Clinical Full-Time Equivalent in PICUs: Survey of the U.S. Pediatric Critical Care Chiefs Network, 2020-2022.

OBJECTIVES: To inform workforce planning for pediatric critical care (PCC) physicians, it is important to understand current staffing models and the spectrum of clinical responsibilities of physicians. Our objective was to describe the expected workload associated with a clinical full-time equivalent (cFTE) in PICUs across the U.S. Pediatric Critical Care Chiefs Network (PC3N). DESIGN: Cross-sectional survey. SETTING: PICUs participating in the PC3N. SUBJECTS: PICU division chiefs or designees participating in the PC3N from 2020 to 2022. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A series of three surveys were used to capture unit characteristics and clinical responsibilities for an estimated 1.0 cFTE intensivist. Out of a total of 156 PICUs in the PC3N, the response rate was 46 (30%) to all three distributed surveys. Respondents used one of four models to describe the construction of a cFTE-total clinical hours, total clinical shifts, total weeks of service, or % full-time equivalent. Results were stratified by unit size. The model used for construction of a cFTE did not vary significantly by the total number of faculty nor the total number of beds. The median (interquartile range) of clinical responsibilities annually for a 1.0 cFTE were: total clinical hours 1750 (1483-1858), total clinical shifts 142 (129-177); total weeks of service 13.0 (11.3-16.0); and total night shifts 52 (36-60). When stratified by unit size, larger units had fewer nights or overnight hours, but covered more beds per shift. CONCLUSIONS: This survey of the PC3N (2020-2022) provides the most contemporary description of clinical responsibilities associated with a cFTE physician in PCC. A 1.0 cFTE varies depending on unit size. There is no correlation between the model used to construct a cFTE and the associated clinical responsibilities.

Small Patients but a Heavy Lift: Workload and Burnout of Advanced Practice Providers and Physicians in a Level IV Neonatal Intensive Care Unit.

OBJECTIVE: This study explored the association between workload and the level of burnout reported by clinicians in our neonatal intensive care unit (NICU). A qualitative analysis was used to identify specific factors that contributed to workload and modulated clinician workload in the NICU. STUDY DESIGN: We conducted a study utilizing postshift surveys to explore workload of 42 NICU advanced practice providers and physicians over a 6-month period. We used multinomial logistic regression models to determine associations between workload and burnout. We used a descriptive qualitative design with an inductive thematic analysis to analyze qualitative data. RESULTS: Clinicians reported feelings of burnout on nearly half of their shifts (44%), and higher levels of workload during a shift were associated with report of a burnout symptom. Our study identified 7 themes related to workload in the NICU. Two themes focused on contributors to workload, 3 themes focused on modulators of workload, and the final 2 themes represented mixed experiences of clinicians' workload. CONCLUSION: We found an association between burnout and increased workload. Clinicians in our study described common contributors to workload and actions to reduce workload. Decreasing workload and burnout along with improving clinician well-being requires a multifaceted approach on unit and systems levels.

Service Improvements and Workload Increases: Royal College of Radiologists (RCR) Re-Audit of Curative Intent Radiotherapy for Non-Small Cell Lung Cancer (NSCLC).

AIMS: The Royal College of Radiologists (RCR) audit of radical radiotherapy (RR) for patients with non-small cell lung cancer (NSCLC) in 2013 concluded that there was under-treatment compared to international comparators and marked variability between cancer networks. Elderly patients were less likely to receive guideline recommended treatments. Access to technological developments was low. Various national and local interventions have since taken place. This study aims to re-assess national practice. MATERIALS AND METHODS: Radiotherapy departments completed one questionnaire for each patient started on RR for 4 weeks in January 2023. RESULTS: Ninety-three percent of centres returned data on 295 patients. RR has increased 70% since 2013 but patients on average wait 20% longer to start treatment (p = 0.02). Staging investigations were often outside a desirable timeframe (79% of PET/CT scans). Advanced planning techniques are used more frequently: 4-dimensional planning increased from 33% to 90% (P < 0.001), cone beam imaging from 67% to 97% (p < 0.001) and colleague led peer review increased from 41% to 73% (P < 0.001). CONCLUSION: There have been significant improvements in care. There has been a considerable increase in clinical oncology workload with evidence of stress on the system that requires additional resourcing.

Swedish maternity care professionals' perception of labor induction.

BACKGROUND: Sweden recently adopted new labor induction guidelines lowering the threshold for post-term pregnancies to 41+ weeks. Despite evidence-based foundation, these guidelines stirred controversy among maternity care professionals, who voiced concerns about potential risks and unintended consequences, such as a rising Caesarean section rate. Midwives also highlighted potential impacts on their roles, workload, and working environment; implications that could affect obstetricians and gynecologists as well. Investigating Swedish maternity care professionals' views on labor induction could benefit policymakers, managers, and birthing women alike. AIM: The aim of this study was to describe and compare midwives to obstetricians/gynecologists, with regards to their views on labor induction, and how this relates to other work-related variables such as overall job satisfaction, clinical experience, gender, age, personality, and workload. METHODS: Swedish midwives (N = 207, 99 % women, M = 45.2 years), and obstetricians/gynecologists (N = 240, 83 % women, M = 44.3 years) responded to an online questionnaire reflecting aspects of maternity care work. The data was analyzed using Welch's t-test and Pearson's correlation analysis. RESULTS: A large difference was observed in labor induction views between midwives and obstetricians/gynecologists (d = 1.39), as well as lower job satisfaction with midwives (d = -0.26). Overall job satisfaction further correlated negatively with views on labor induction (r = -0.30). CONCLUSIONS: Labor inductions might pose challenges to midwives and could bring to light underlying tensions between obstetricians/gynecologists and midwives. Given the modest response rate of the study, we cautiously suggest that while the development of new maternity care guidelines should be grounded in evidence, they should also embrace concerns and insights from a diversity of professional perspectives.

Low back pain, work overload, and associated factors among hospital caregivers.

BACKGROUND: Caregivers assist patients in treatment based on their care needs and living activities. Very few studies have been conducted specifically on the occupational health and safety of hospital caregivers. OBJECTIVE: This study aimed to investigate the prevalence of excessive workload and low back pain among hospital caregivers and to identify potential associated factors. METHODS: This cross-sectional study included caregivers working at Gazi University Hospital. Socio-demographic and working-life characteristics were assessed. The Role Overload Scale was used to determine excessive workload and the Roland-Morris Disability Questionnaire was used to evaluate low back pain. RESULTS: The study included 528 participants. A total of 18.7% had work accidents in their department. 49.0% had sharp injuries. 68.9% of the participants performed tasks such as positioning, turning, lifting, or helping patients to walk. 72.2% stood for a long time during the workday. 52.8% thought that they worked under stress. 57.6% had low back pain in the last year and 38.6% in the last month, Significant differences exist in low back pain according to gender, body-mass index, standing for a long time and working under stress. Those who worked at night, had a work accident, positioned patients, stood for a long time, and worked under stress had higher mean scores on the Role Overload Scale. CONCLUSION: Tools should be used to lift and transport patients. In addition to occupational health and safety training, awareness of musculoskeletal risks should be increased. Employee well-being can be improved through exercise and stress reduction techniques.

Is the National Early Warning Score able to identify nursing activity load? A prospective observational study.

BACKGROUND: The National Early Warning Score scale correlates well with the intensity of the patient's acute condition. It could also correlate with the nursing activity load and prove useful in defining and redistributing nursing resources based on the acuity of patients. AIM: To assess whether patients' National Early Warning Score at hospital admission correlates with objective nursing demands and can be used to optimize the distribution of available care resources. METHODS: This single-center prospective study included patients admitted to the Department of Internal Medicine at the Civil Hospital in Altovicentino (Italy) between September 1 and December 31, 2022. Nursing activities were recorded for the first three days after admission and standardized to the daily mean as performance/5 min/patient/day. Linear regression was used to assess the correlation between nursing demands for different National Early Warning Scores. RESULTS: This study included 333 patients. Their mean National Early Warning Score was 3.9 (standard deviation: 2.9), with 61 % (203/333) in the National Early Warning Score <5 category, 19.5 % (65/333) in the National Early Warning Score 5-6 category, and 19.5 % (65/333) in the National Early Warning Score >6 category. Their average daily care requirements increased from 22 (16-30) activities/5 min/patient/day in the low National Early Warning Score category to 30 (20-39) activities/5 min/patient/day in the intermediate National Early Warning Score category (p < 0.001) and 35 (23-45) activities/5 min/patient/day in the high National Early Warning Score category (p < 0.001). CONCLUSION: The National Early Warning Score correlates with nursing care activities for patients with an acute condition and can be used to optimize the distribution of available care resources.

Analysis of the association between high workload and musculoskeletal pain in public school teachers according to physical activity level.

BACKGROUND: A high workload has been associated with musculoskeletal pain in public school teachers. However, the hypothesis of the present study was that physical activity (PA) practice is able to attenuate this association. OBJECTIVE: To analyze the associations between high workload with musculoskeletal pain according to PA levels in public school teachers. METHODS: Teachers (n = 239) from 13 public schools were evaluated. Workload was assessed using a Likert scale in which teachers reported their perception of their work routine as: very low, low, regular, high, and very high. Musculoskeletal pain and PA were assessed using questionnaires. Multivariate logistic regression models were used to investigate the association of high workload with PA levels and musculoskeletal pain in different body regions, compared to participants with normal workload, adjusted by sex, age, and socioeconomic status. RESULTS: A high workload was associated with higher chances of reporting pain in the wrists and hands (OR = 3.55; 95% CI = 1.27-9.89), knee (OR = 3.09; 95CI%  = 1.09-8.82), and feet and ankles (OR = 3.16; 95% CI = 1.03-9.76) in less active teachers. However, these associations were not observed in teachers considered more active. CONCLUSION: PA practice is able to act as a good protector against musculoskeletal pain in teachers, even in individuals with a high workload.

Revision Total Joint Arthroplasty Places a Disproportionate Burden on Surgeons: A Comparison Using the National Aeronautics and Space Administration Task Load Index (NASA TLX).

BACKGROUND: Perceived surgeon workload of performing primary and revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) is challenging to quantify. The National Aeronautics and Space Administration Task Load Index (NASA TLX) survey was developed to quantify experiences following aviation and has been applied to healthcare fields. Our purposes were to 1) quantify the workload endured by surgeons who are performing primary and revision TKA and THA and 2) compare these values to their Center for Medicare & Medicaid Services (CMS) reimbursement. METHODS: A prospective cohort of 5 fellowship-trained adult reconstruction surgeons completed NASA TLX surveys following primary and revision TKA/THA cases. A total of 122 surveys consisting of 70 TKA (48 primaries and 22 revisions) and 55 THA surveys (38 primaries and 17 revisions) were completed. Patient demographics and surgical variables were recorded. Final NASA TLX workloads were compared to 2021 CMS work relative value units. RESULTS: Compared to primary TKA, revision TKA had 176% increased intraoperative workload (P < .001), 233% increased mental burden (P < .001), and 150% increased physical burden (P < .001). Compared to primary THA, revision THA had 106% increased intraoperative workload (P < .001), 96% increased mental burden (P < .001), and 91% increased physical burden (P < .001). Operative time was higher in revision versus primary TKA (118 versus 84.5 minutes, P = .05) and THA (150 versus 115 minutes, P = .001). Based upon 2021 CMS data, revision TKA and THA would need to be compensated by an additional 36% and 12.3%, respectively, to parallel intraoperative efforts. CONCLUSIONS: Revision hip and knee arthroplasty places a major mental and physical workload upon surgeons and is disproportionately compensated by CMS.

How Education Shapes Women's Work and Family Lives Across Race and Ethnicity.

Drawing on life course and intersectional approaches, this study examines how education shapes the intertwined domains of work and family across race and ethnicity. By applying multichannel sequence analysis and cluster analysis to the National Longitudinal Survey of Youth 1979, we identify a typology of life course trajectories of work and family and test for the interactive associations of race and ethnicity with college education for different trajectory types. While our results show statistically significant and often sizable education effects across racial and ethnic groups for most of the work‒family clusters, they also suggest that the size and direction of the education effect vary widely across groups. Educational attainment plays an outsize role in shaping Black women's work‒family lives, increasing their access to steady work and partnerships, while educational attainment primarily works to increase White women's participation in part-time work. In contrast, Latina women's work‒family trajectories are less responsive to their educational attainment. In combination, the racialized role of education and persistent racial and ethnic gaps across the education distribution yield unequal patterns in work‒family strategies among Black, Latina, and White women.

Physiological workload assessment with the help of heart rate and perceived exertion rating on handcart pullers of wholesale trade markets of Delhi.

Background . Handling a heavy load on a handcart is common in the wholesale and retail trade markets in India and many parts of the globe. These carts transport goods between major markets, warehouses and transporters. We assessed the physiological workload among handcart pullers in terms of cardiovascular load (CVL), energy expenditure (EE), heart rate (HR), physiological cost of work and subjective rating of perceived exertion. Methods . Physiological workload was assessed with the help of HR during resting, working (15 minutes) and recovery state with a smart wearable device to extrapolate percentage of CVL, EE and physiological cost of work among handcart pullers. Subjective assessment of exertion was measured with the Borg 5-point rating scale among 35 cart pullers. Data were analysed using Microsoft Excel version 2010. Results . It was found that in handcart-pulling activity, EE was 11.706 kJ/minute, average working HR was 128 beats/minute and physiological cost of work was 89.09 beats/minute with no loads on handcart. This signifies that the activity falls under heavy physiological workload. The average percentage of CVL was found to be 50.5%, which falls under acceptable category for persons with a healthy cardiovascular system. Thirty-one (88.6%) of the participants reported the activity to be moderately heavy, whereas 4 (11.4%) participants mentioned it to be light. Conclusions . Handcart-pulling operation in this study without load on cart was found to be a heavy physiological workload. In real-time situations, the load, road conditions, long duration and traffic congestion is likely to result in a higher range of physiological workload on cart pullers.

Correlation of the COVID-19 Infection and Outcomes with Workload among Emergency Healthcare Workers in an Iranian Referral Hospital.

The immediate spread of COVID-19 posed a great deal of strain on healthcare personnel, particularly emergency personnel. Considering the critical role of frontline health care personnel (HCPs) during the pandemic and the life-threatening effects of COVID-19 on them, the present study aimed to evaluate the hospital database among frontline emergency personnel, and to assess the factors affecting the health status of the emergency HCPs. In the current study, we collected data on coronavirus clinical features from 58 HCPs with confirmed COVID-19 who worked in the emergency ward of Baqiyatallah Hospital, Tehran, one of the most referral hospitals in Iran. We also assessed the factors affecting the health status of the emergency HCPs from February 2020 to November 2020. All of the 58 HCPs infected with COVID-19 were the personnel of the emergency ward with an age range of 20-59 years old. The median (interquartile range) of hospital length of stay (LOS) among all patients was 8 days. Length of stay is a critical factor in predicting hospital resource needs. Twelve (21.8%) patients had ground-glass opacity (GGO) alone, and 20 (35.7%) patients had patchy GGO. In our multivariable analysis, high levels of patient liver enzymes (P=0.04) and lymphopenia (P=0.01) were significantly associated with the LOS. In our study, there was an association between high levels of patient's ESR and CRP and longer LOS. We also found that age and gender had no effect on LOS. Nurses contributed to the highest number of COVID-19 infection. It was also found that HCPs who had more working shifts were more infected, and the intensive care unit of the emergency ward was the most infected area of the Emergency Room.

Analysis of the Effects of a Texas State-Wide Mask Mandate (Executive Order GA-29) on Case Load, Hospitalizations, and Mortality.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has resulted in unprecedented hospitalizations, ventilator use, and deaths. Because of concerns for resource utilization and surges in hospital capacity use, Texas Executive Order GA-29 required statewide mask wear beginning July 3, 2020. Our objective was to compare COVID-19 case load, hospital bed use, and deaths before and after implementation of this mask order. METHODS: This was a retrospective observational study using publicly reported statewide data to perform a mixed-methods interrupted time series analysis. We compared outcomes before and after the statewide mask wear mandate per Executive Order GA-29. The preorder period was from June 19 to July 2, 2020. The postorder period was July 17 to September 17, 2020. Outcomes included daily COVID-19 case load, hospitalizations, and mortality. RESULTS: The daily case load before the mask order per 100,000 individuals was 187.5 (95% confidence interval [CI] 157.0-217.0) versus 200.7 (95% CI 179.8-221.6) after GA-29. The number of daily hospitalized patients with COVID-19 was 171.4 (95% CI 143.8-199.0) before GA-29 versus 225.1 (95% CI 202.9-247.3) after. Daily mortality was 2.4 (95% CI 1.9-2.9) before GA-29 versus 5.2 (95% CI 4.6-5.8). There was no material impact on our results after controlling for economic activity. CONCLUSIONS: In both adjusted and unadjusted analyses, we were unable to detect a reduction in case load, hospitalization rates, or mortality associated with the implementation of an executive order requiring a statewide mask order. These results suggest that during a period of rapid virus spread, additional public health measures may be necessary to mitigate transmission at the population level.

Trend in radiologist workload compared to number of admissions in the emergency department.

INTRODUCTION: Recent years have shown an increase in radiologists' workload, both during regular working hours and during on-call. We aimed to quantify the 8-year trend in on-call workload in a large tertiary academic medical center, and to compare the workload growth rate to emergency department (ED) visits growth rate during the same period. METHODS: The number of computed tomography (CT) studies during on-call hours (weekdays between 3.00 p.m. and 8.00 a.m., and weekends) between 2012 and 2019 was extracted from our hospital's Radiologic Information System. To estimate the on-call workload, all studies were converted to relative value units (RVUs) using the US Medicare physician reimbursement tables. The Kendall's tau b test was used to assess the temporal trend. RESULTS: Overall, on-call CT RVUs increased by 52% (Kendall's tau b = 0.776, p = 0.001) while ED visit rate grew by 23% with a weaker correlation coefficient (Kendall's tau b = 0.323, p = 0.009). RVUs of brain CT, the most prevalent examination type, increased by 33%, while abdominal CT, the second most prevalent examination, increased by 70%. Thoracic-lumbar spine CT examinations increased by 1375% and head and neck CT angiography examinations (stroke protocol and CT-Venography) grew by 287%. CONCLUSIONS: Radiologists' on-call workload more than doubled the growth rate of ED visits over an 8-year period. Radiologists, radiographers and on-call ED workforce should be adjusted to accommodate these evolving changes to enhance quality and safety of patient care and to avoid caregivers' burnout.

Rapid redesign and effect on clinical workload of a supra-regional burns and plastic surgery service during the COVID-19 pandemic.

INTRODUCTION: In March 2020, South Wales experienced the most significant COVID-19 outbreak in the UK outside of London. We share our experience of the rapid redesign and subsequent change in activity in one of the busiest supra-regional burns and plastic surgery services in the UK. METHODS: A time-matched retrospective service evaluation was completed for a 7-week "COVID-19" study period and the equivalent weeks in 2018 and 2019. The primary aim of this study was to evaluate plastic surgery theatre use and the impact of service redesign. Comparison between study periods was tested for statistical significance using two-tailed t-tests. RESULTS: Operation numbers reduced by 64% and total operating time by 70%. General anaesthetic cases reduced from 41% to 7% (p<0.0001), and surgery was mainly carried out in ringfenced daycase theatres. Emergency surgery decreased by 84% and elective surgery by 46%. Cancer surgery as a proportion of total elective operating increased from 51% to 96% (p<0.0001). The absolute number of cancer-related surgeries undertaken was maintained despite the pandemic. CONCLUSION: Rapid development of COVID-19 SOPs minimised inpatient admissions. There was a significant decrease in operating while maintaining emergency and cancer surgery. Our ringfenced local anaesthetic Plastic Surgery Treatment Centre was essential in delivering a service. COVID-19 acted as a catalyst for service innovations and the uptake of activities such as telemedicine, virtual MDTs, and online webinars. Our experiences support the need for a core burns and plastic service during a pandemic, and show that the service can be effectively redesigned at speed.

Analysis of Surgical Volume in Military Medical Treatment Facilities and Clinical Combat Readiness of US Military Surgeons.

Importance: Low surgical volume in the US Military Health System (MHS) has been identified as a challenge to military surgeon readiness. The Uniformed Services University of Health Sciences, in partnership with the American College of Surgeons, developed the Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program that includes a tool for quantifying the clinical readiness value of surgeon workload, known as the KSA metric. Objective: To describe changes in US military general surgeon procedural volume and readiness using the KSA metric. Design, Setting, and Participants: This cohort study analyzed general surgery workload performed across the MHS, including military and civilian facilities, between fiscal year 2015 and 2019 and the calculated KSA metric value. The surgeon-level readiness among military general surgeons was calculated based on the KSA metric readiness threshold. Data were obtained from TRICARE, the US Department of Defense health insurance product. Main Outcomes and Measures: The main outcomes were general surgery procedural volumes and the KSA metric point value of those procedures across the MHS as well as the number of military general surgeons meeting the KSA metric readiness threshold. Aggregate facility and regional market-level claims data were used to calculate the procedural volumes and KSA metric readiness value of those procedures. Annual adjusted KSA metric points earned were used to determine the number of individual US military general surgeons meeting the readiness threshold. Results: The number of general surgery procedures generating KSAs in military hospitals decreased 25.6%, from 128 377 in 2015 to 95 461 in 2019, with a 19.1% decrease in the number of general surgeon KSA points (from 7 155 563 to 5 790 001). From 2015 to 2019, there was a 3.2% increase in both the number of procedures (from 419 980 to 433 495) and KSA points (from 21 071 033 to 21 748 984) in civilian care settings. The proportion of military general surgeons meeting the KSA metric readiness threshold decreased from 16.7% (n = 97) in 2015 to 10.1% (n = 68) in 2019. Conclusions and Relevance: This study noted that the number of KSA metric points and procedural volume in military hospitals has been decreasing since 2015, whereas both measures have increased in civilian facilities. The findings suggest that loss of surgical workload has resulted in further decreases in military surgeon readiness and may require substantial changes in patient care flow in the MHS to reverse the change.

Surgeon volume and established hospital perioperative mortality rate together predict for superior outcomes after open abdominal aortic aneurysm repair.

BACKGROUND: In 2018, the Society for Vascular Surgery (SVS) published hospital volume guidelines for elective open abdominal aortic aneurysm (AAA) repair, recommending that elective open surgical repair of AAAs should be performed at centers with an annual volume of ≥10 open aortic operations of any type and a documented perioperative mortality of ≤5%. Recent work has suggested a yearly surgeon volume of at least seven open aortic cases for improved outcomes. The objective of the present study was to assess the importance of hospital volume and surgeon volume at these cut points for predicting 1-year mortality after open surgical repair of AAAs. METHODS: We evaluated patients who had undergone elective open AAA repair using the New York Statewide Planning and Research Cooperative System database from 2003 to 2014. The effect of the SVS guidelines on postoperative mortality and complications was evaluated. Confounding between the hospital and surgeon volumes was identified using mixed effects multivariate Cox proportional hazards analysis. The effect of the interactions between hospital volume, established hospital perioperative survival, and surgeon volume on postoperative outcomes was also investigated. RESULTS: The cohort consisted of 7594 elective open AAA repairs performed by 542 surgeons in 137 hospitals during the 12-year study period. Analysis of the 2018 guidelines using the Statewide Planning and Research Cooperative System database revealed 1-year and 30-day mortality rates of 9.2% (range, 8.3%-10.1%) and 3.5% (range, 2.9%-4.1%) for centers that were within the SVS guidelines and 13.6% (range, 12.5%-14.7%) and 6.9% (range, 6.1%-7.8%) for those that were outside the guidelines, respectively (P < .001 for both). Multivariate survival analysis revealed a hazard ratio for a surgeon volume of ≥7, hospital volume of ≥10, and hospital 3-year perioperative mortality of ≤5% of 0.80 (95% confidence interval [CI], 0.70-0.93; P = .003), 0.91 (95% CI, 0.77-1.08; P = .298), and 0.72 (95% CI, 0.62-0.82; P < .001), respectively. Additionally, procedures performed by surgeons with a yearly average volume of open aortic operations of at least seven and at hospitals with an established elective open AAA repair perioperative mortality rate of ≤5% showed improved 1-year (33.2% relative risk reduction; P < .001) and 30-day (P = .001) all-cause survival and improved postoperative complication rates. CONCLUSIONS: These data have demonstrated that centers that meet the SVS AAA volume guidelines are associated with improved 1-year and 30-day all-cause survival. However, the results were confounded by surgeon volume. A surgeon open aortic volume of at least seven procedures and an established hospital perioperative mortality of ≤5% each independently predicted for 1-year survival after open AAA repair, with the hospital volume less important. These results indicate that surgeons with an annual volume of at least seven open aortic operations of any type should perform elective open AAA repair at centers with a documented perioperative mortality of ≤5%.