VascularWeb Home

• Press Center
• Press Release Archive
• Media Kit
• SAAAVE Act Campaign
• Press Releases from 2008 Annual Meeting
• JVS Press Releases
• SVS Position Statements
• Contact Us

Home > Press Center > Press Releases from 2007 Annual Meeting > Registry Helps Vascular Surgeons Improve Care, Surgical Outcomes

Contact:
Emily Kalata
Assistant Director, Communications
312.334.2309

Outcomes from an ongoing regional registry about carotid endarterectomy (CEA), lower extremity bypass (LEB) and infrarenal abdominal aortic aneurysm (AAA) repairs, was presented today at the 61st Annual Meeting of the Society for Vascular Surgery. The mission of the registry is to allow benchmarking among participating centers and improve the care process and patients’ surgical outcomes.    

Forty-five vascular surgeons from eight hospitals in Maine, New Hampshire and Vermont formed The Vascular Study Group of Northern New England (VSGNNE) and have prospectively recorded patient procedures, risk factors and in-hospital outcome data since 2003. More than 6,000 operations have been entered into the registry.    

Mortality was accurately recorded in all but one patient. Postoperative complication (stroke; bleeding; myocardial infarction; congestive heart failure; respiratory or renal conditions; ischemia or infection; or re-operation) varied between hospitals and all increased median length of stay three or more days. Researchers said that in-hospital and one-year outcomes are similar to single centers, however there is variation among centers. Risk prediction models are being developed to determine how these variations impact different patient factors vs. processes of care, and how both could be improved.

Current and future improvement efforts are focused on reducing complications by altering care processes based on group consensus. Jack L. Cronenwett, MD, department of vascular surgery section chief at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. said the VSGNNE has implemented quality improvement efforts for preoperative medication use to reduce operative morbidity. Improvements have increased preoperative beta-blockers from 72 to 88 percent, antiplatelet agents (aspirin-Plavix) from 74 to 83 percent and statins from 50 to 70 percent. 

“Key outcomes have been quite good when compared to other published results,” added Dr. Cronenwett. “Stroke and death following CEA was 1.3 percent; major amputation or death following LEB was 4.1 percent; and death following AAA repair was 2.7 percent for open surgery and 0.5 percent for endovascular repair.  

“Our efforts focus on analyzing risk-adjusted outcomes to better understand centers’ variation and improve patient selection. Through collection and exchange of information the VSGNNE strives to continuously improve quality, safety, effectiveness and cost of care. Participating surgeons have generated benchmarks and leveraged experience to improve care processes. The registry data allows them to discuss techniques or management that could affect outcome,” added Dr. Cronenwett.

Researchers noted that their initiative is not only an appropriate vehicle for public and pay-for-performance reporting and has the potential to improve patient outcomes, but that the registry has been a durable model that could be adopted by other regions.

Results plus one-year follow-up data, analyzed at a central site, are reported anonymously to each center at semiannual 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. Processes and regional benchmarks are discussed. 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.