Updated Registry Aids Vascular Surgeons
November 28, 2007 - Recent statistical updates are published in the December 2007 issue of the Journal of Vascular Surgery that compare carotid endarterectomy (CEA), lower extremity bypass (LEB) and infrarenal abdominal aortic aneurysm (AAA) (both open and endovascular repairs).
Between 2003 and December 2006, forty-eight vascular surgeons from nine hospitals that comprise the Vascular Study Group of Northern New England recorded prospective data from 6,143 patient procedures (83 percent had follow-up data at one year), risk factors and in-hospital outcomes.
"The latest data shows stroke and death following CEA was 1.0 percent; major amputation or death following LEB was 3.8 percent; and death following AAA repair was 2.9 percent for open surgery and 0.4 percent for endovascular repair," said Jack L. Cronenwett, M.D., department of Vascular Surgery section chief at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.
"The Vascular Study Group of Northern New England registry data allows surgeons to discuss techniques or management that could affect outcomes in the future," said Dr. Cronenwett. "Our efforts focus on analyzing risk-adjusted outcomes to better understand the centers' variation and improve patient selection, while striving to continuously improve quality, safety, effectiveness and cost of care. This registry is a model that could be adopted by other regions for improving patient outcomes and enabling pay-for-performance reporting."
Dr. Cronenwett added that one of the most important accomplishments of the registry has been the success of process improvement efforts. "For example, our new data shows we have significantly increased pre-operative beta-blockers from 72 percent to 91 percent; antiplatelet agents from 73 percent to 83 percent and statins from 54 percent to 72 percent," he said.
Results are analyzed at a central site and then reported anonymously to each center at bi-annual meetings. Mortality and compliance with procedure entry are validated by independent comparison with hospital administrative data through a centralized audit. This data also are used to audit compliance with procedure entry in order to ensure accuracy. Reports include key process and outcome variables, so that each center and surgeon can assess their results in comparison to the entire group over time.
For more information: www.jvascsurg.org
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