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1. Editor's Choice – Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands

Author

Hamid Jalalzadeh, Reza Indrakusuma, Mark J.W. Koelemay, Ron Balm, L.H. Van den Akker, P.J. Van den Akker, G.J. Akkersdijk, G.P. Akkersdijk, W.L. Akkersdijk, M.G. van Andringa de Kempenaer, C.H. Arts, J.A. Avontuur, J.G. Baal, O.J. Bakker, R. Balm, W.B. Barendregt, M.H. Bender, B.L. Bendermacher, M. van den Berg, P. Berger, R.J. Beuk, J.D. Blankensteijn, R.J. Bleker, J.H. Bockel, M.E. Bodegom, K.E. Bogt, A.P. Boll, M.H. Booster, B.L. Borger van der Burg, G.J. de Borst, W.T. Bos-van Rossum, J. Bosma, J.M. Botman, L.H. Bouwman, J.C. Breek, V. Brehm, M.J. Brinckman, T.H. van den Broek, H.L. Brom, M.T. de Bruijn, J.L. de Bruin, P. Brummel, J.P. van Brussel, S.E. Buijk, M.G. Buimer, D.H. Burger, H.C. Buscher, G. den Butter, E. Cancrinus, P.H. Castenmiller, G. Cazander, H.M. Coveliers, P.H. Cuypers, J.H. Daemen, I. Dawson, A.F. Derom, A.R. Dijkema, J. Diks, M.K. Dinkelman, M. Dirven, D.E. Dolmans, R.C. van Doorn, L.M. van Dortmont, M.M. van der Eb, D. Eefting, G.J. van Eijck, J.W. Elshof, B.H. Elsman, A. van der Elst, M.I. van Engeland, R.G. van Eps, M.J. Faber, W.M. de Fijter, B. Fioole, W.M. Fritschy, R.H. Geelkerken, W.B. van Gent, G.J. Glade, B. Govaert, R.P. Groenendijk, H.G. de Groot, R.F. van den Haak, E.F. de Haan, G.F. Hajer, J.F. Hamming, E.S. van Hattum, C.E. Hazenberg, P.P. Hedeman Joosten, J.N. Helleman, L.G. van der Hem, J.M. Hendriks, J.A. van Herwaarden, J.M. Heyligers, J.W. Hinnen, R.J. Hissink, G.H. Ho, P.T. den Hoed, M.T. Hoedt, F. van Hoek, R. Hoencamp, W.H. Hoffmann, A.W. Hoksbergen, E.J. Hollander, L.C. Huisman, R.G. Hulsebos, K.M. Huntjens, M.M. Idu, M.J. Jacobs, M.F. van der Jagt, J.R. Jansbeken, R.J. Janssen, H.H. Jiang, S.C. de Jong, V. Jongkind, M.R. Kapma, B.P. Keller, A. Khodadade Jahrome, J.K. Kievit, P.L. Klemm, P. Klinkert, B. Knippenberg, N.A. Koedam, M.J. Koelemay, J.L. Kolkert, G.G. Koning, O.H. Koning, A.G. Krasznai, R.M. Krol, R.H. Kropman, R.R. Kruse, L. van der Laan, M.J. van der Laan, J.H. van Laanen, J.H. Lardenoye, J.A. Lawson, D.A. Legemate, V.J. Leijdekkers, M.S. Lemson, M.M. Lensvelt, M.A. Lijkwan, R.C. Lind, F.T. van der Linden, P.F. Liqui Lung, M.J. Loos, M.C. Loubert, D.E. Mahmoud, C.G. Manshanden, E.C. Mattens, R. Meerwaldt, B.M. Mees, R. Metz, R.C. Minnee, J.C. de Mol van Otterloo, F.L. Moll, Y.C. Montauban van Swijndregt, M.J. Morak, R.H. van de Mortel, W. Mulder, S.K. Nagesser, C.C. Naves, J.H. Nederhoed, A.M. Nevenzel-Putters, A.J. de Nie, D.H. Nieuwenhuis, J. Nieuwenhuizen, R.C. van Nieuwenhuizen, D. Nio, A.P. Oomen, B.I. Oranen, J. Oskam, H.W. Palamba, A.G. Peppelenbosch, A.S. van Petersen, T.F. Peterson, B.J. Petri, M.E. Pierie, A.J. Ploeg, R.A. Pol, E.D. Ponfoort, P.P. Poyck, A. Prent, S. ten Raa, J.T. Raymakers, M. Reichart, B.L. Reichmann, M.M. Reijnen, A. Rijbroek, M.J. van Rijn, R.A. de Roo, E.V. Rouwet, C.G. Rupert, B.R. Saleem, M.R. van Sambeek, M.G. Samyn, H.P. van ’t Sant, J. van Schaik, P.M. van Schaik, D.M. Scharn, M.R. Scheltinga, A. Schepers, P.M. Schlejen, F.J. Schlosser, F.P. Schol, O. Schouten, M.H. Schreinemacher, M.A. Schreve, G.W. Schurink, C.J. Sikkink, M.P. Siroen, A. te Slaa, H.J. Smeets, L. Smeets, A.A. de Smet, P. de Smit, P.C. Smit, T.M. Smits, M.G. Snoeijs, A.O. Sondakh, T.J. van der Steenhoven, S.M. van Sterkenburg, D.A. Stigter, H. Stigter, R.P. Strating, G.N. Stultiëns, J.E. Sybrandy, J.A. Teijink, B.J. Telgenkamp, M.J. Testroote, R.M. The, W.J. Thijsse, I.F. Tielliu, R.B. van Tongeren, R.J. Toorop, J.H. Tordoir, E. Tournoij, M. Truijers, K. Türkcan, R.P. Tutein Nolthenius, Ç. Ünlü, A.A. Vafi, A.C. Vahl, E.J. Veen, H.T. Veger, M.G. Veldman, H.J. Verhagen, B.A. Verhoeven, C.F. Vermeulen, E.G. Vermeulen, B.P. Vierhout, M.J. Visser, J.A. van der Vliet, C.J. Vlijmen - van Keulen, H.G. Voesten, R. Voorhoeve, A.W. Vos, B. de Vos, G.A. Vos, B.H. Vriens, P.W. Vriens, A.C. de Vries, J.P. de Vries, M. de Vries, C. van der Waal, E.J. Waasdorp, B.M. Wallis de Vries, L.A. van Walraven, J.L. van Wanroij, M.C. Warlé, V. van Weel, A.M. van Well, G.M. Welten, R.J. Welten, J.J. Wever, A.M. Wiersema, O.R. Wikkeling, W.I. Willaert, J. Wille, M.C. Willems, E.M. Willigendael, W. Wisselink, M.E. Witte, C.H. Wittens, I.C. Wolf-de Jonge, O. Yazar, C.J. Zeebregts, M.L. van Zeeland, Surgery, ACS - Atherosclerosis & ischemic syndromes, Pathology, VU University medical center, Pediatrics, Dermatology, ACS - Microcirculation, ACS - Diabetes & metabolism, Graduate School, 02 Surgical specialisms, ​Robotics and image-guided minimally-invasive surgery (ROBOTICS), Neurology, Erasmus MC other, Molecular Genetics, Erasmus School of Economics, Socio-Medical Sciences (SMS), Cell biology, Gynecological Oncology, Research & Education, Child and Adolescent Psychiatry / Psychology, Cardiology, Urology, Erasmus School of Health Policy & Management, Erasmus School of Social and Behavioural Sciences, Erasmus School of Law, Department of History, Department of Psychology, Education and Child Studies, Obstetrics & Gynecology, Department of Finance, General Practice, Applied Economics, Pediatric Surgery, Department of Business-Society Management, Commercial Law and Financial Law, Radiology & Nuclear Medicine, Business Economics, Neurosurgery, Public Health, Anesthesiology, Internal Medicine, Hematology, Intensive Care, Psychiatry, WP ESPhil, and Gastroenterology & Hepatology

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Iliac Aneurysm/epidemiology, Patient characteristics, Netherlands/epidemiology, 030204 cardiovascular system & hematology, 030230 surgery, Iliac Artery/pathology, Endovascular aneurysm repair, Iliac Artery, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Sex Factors, medicine, 80 and over, Humans, EVAR, Registries, Iliac artery aneurysm, Aged, Netherlands, Retrospective Studies, Surgical repair, Aged, 80 and over, business.industry, Open repair, Endovascular Procedures, Retrospective cohort study, Guideline, Vascular surgery, medicine.disease, Guideline Adherence/statistics & numerical data, Surgery, Endovascular Procedures/methods, Aneurysm repair, Treatment Outcome, Iliac Aneurysm, Female, Guideline Adherence, Cardiology and Cardiovascular Medicine, business
Abstract

OBJECTIVE: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR).METHODS: This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests.RESULTS: The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38-50) mm and 68 (IQR 58-85) mm, respectively. Mortality was 1.3% (95% CI 0.7-2.4) after eIAA repair and 25.5% (95% CI 18.0-34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively).CONCLUSION: In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair.

Published
2020
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2. Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit

Author

Niki Lijftogt, Anco Vahl, Esmee M. van der Willik, Vanessa J. Leijdekkers, Michel W.J.M. Wouters, Jaap F. Hamming, L.H. Van den Akker, P.J. Van den Akker, G.J. Akkersdijk, G.P. Akkersdijk, W.L. Akkersdijk, M.G. van Andringa de Kempenaer, C.H. Arts, J.A. Avontuur, J.G. Baal, O.J. Bakker, R. Balm, W.B. Barendregt, M.H. Bender, B.L. Bendermacher, M. van den Berg, P. Berger, R.J. Beuk, J.D. Blankensteijn, R.J. Bleker, J.H. Bockel, M.E. Bodegom, K.E. Bogt, A.P. Boll, M.H. Booster, B.L. Borger van der Burg, G.J. de Borst, W.T. Bos-van Rossum, J. Bosma, J.M. Botman, L.H. Bouwman, J.C. Breek, V. Brehm, M.J. Brinckman, T.H. van den Broek, H.L. Brom, M.T. de Bruijn, J.L. de Bruin, P. Brummel, J.P. van Brussel, S.E. Buijk, M.G. Buimer, D.H. Burger, H.C. Buscher, G. den Butter, E. Cancrinus, P.H. Castenmiller, G. Cazander, H.M. Coveliers, P.H. Cuypers, J.H. Daemen, I. Dawson, A.F. Derom, A.R. Dijkema, J. Diks, M.K. Dinkelman, M. Dirven, D.E. Dolmans, R.C. van Doorn, L.M. van Dortmont, M.M. van der Eb, D. Eefting, G.J. van Eijck, J.W. Elshof, B.H. Elsman, A. van der Elst, M.I. van Engeland, R.G. van Eps, M.J. Faber, W.M. de Fijter, B. Fioole, W.M. Fritschy, R.H. Geelkerken, W.B. van Gent, G.J. Glade, B. Govaert, R.P. Groenendijk, H.G. de Groot, R.F. van den Haak, E.F. de Haan, G.F. Hajer, J.F. Hamming, E.S. van Hattum, C.E. Hazenberg, P.P. Hedeman Joosten, J.N. Helleman, L.G. van der Hem, J.M. Hendriks, J.A. van Herwaarden, J.M. Heyligers, J.W. Hinnen, R.J. Hissink, Ho GH, P.T. den Hoed, M.T. Hoedt, F. van Hoek, R. Hoencamp, W.H. Hoffmann, A.W. Hoksbergen, E.J. Hollander, L.C. Huisman, R.G. Hulsebos, K.M. Huntjens, M.M. Idu, M.J. Jacobs, M.F. van der Jagt, J.R. Jansbeken, R.J. Janssen, H.H. Jiang, S.C. de Jong, V. Jongkind, M.R. Kapma, B.P. Keller, A. Khodadade Jahrome, J.K. Kievit, P.L. Klemm, P. Klinkert, B. Knippenberg, N.A. Koedam, M.J. Koelemaij, J.L. Kolkert, G.G. Koning, O.H. Koning, A.G. Krasznai, R.M. Krol, R.H. Kropman, R.R. Kruse, L. van der Laan, M.J. van der Laan, J.H. van Laanen, J.H. Lardenoye, J.A. Lawson, D.A. Legemate, V.J. Leijdekkers, M.S. Lemson, M.M. Lensvelt, M.A. Lijkwan, R.C. Lind, F.T. van der Linden, P.F. Liqui Lung, M.J. Loos, M.C. Loubert, D.E. Mahmoud, C.G. Manshanden, E.C. Mattens, R. Meerwaldt, B.M. Mees, R. Metz, R.C. Minnee, J.C. de Mol van Otterloo, F.L. Moll, Y.C. Montauban van Swijndregt, M.J. Morak, R.H. van de Mortel, W. Mulder, S.K. Nagesser, C.C. Naves, J.H. Nederhoed, A.M. Nevenzel-Putters, A.J. de Nie, D.H. Nieuwenhuis, J. Nieuwenhuizen, R.C. van Nieuwenhuizen, D. Nio, A.P. Oomen, B.I. Oranen, J. Oskam, H.W. Palamba, A.G. Peppelenbosch, A.S. van Petersen, T.F. Peterson, B.J. Petri, M.E. Pierie, A.J. Ploeg, R.A. Pol, E.D. Ponfoort, P.P. Poyck, A. Prent, S. ten Raa, J.T. Raymakers, M. Reichart, B.L. Reichmann, M.M. Reijnen, A. Rijbroek, M.J. van Rijn, R.A. de Roo, E.V. Rouwet, C.G. Rupert, B.R. Saleem, M.R. van Sambeek, M.G. Samyn, H.P. van 't Sant, J. van Schaik, P.M. van Schaik, D.M. Scharn, M.R. Scheltinga, A. Schepers, P.M. Schlejen, F.J. Schlosser, F.P. Schol, O. Schouten, M.H. Schreinemacher, M.A. Schreve, G.W. Schurink, C.J. Sikkink, M.P. Siroen, A. te Slaa, H.J. Smeets, L. Smeets, A.A. de Smet, P. de Smit, P.C. Smit, T.M. Smits, M.G. Snoeijs, A.O. Sondakh, T.J. van der Steenhoven, S.M. van Sterkenburg, D.A. Stigter, H. Stigter, R.P. Strating, G.N. Stultiëns, J.E. Sybrandy, J.A. Teijink, B.J. Telgenkamp, M.J. Testroote, R.M. The, W.J. Thijsse, I.F. Tielliu, R.B. van Tongeren, R.J. Toorop, J.H. Tordoir, E. Tournoij, M. Truijers, K. Türkcan, R.P. Tutein Nolthenius, Ç. Ünlü, A.A. Vafi, A.C. Vahl, E.J. Veen, H.T. Veger, M.G. Veldman, H.J. Verhagen, B.A. Verhoeven, C.F. Vermeulen, E.G. Vermeulen, B.P. Vierhout, M.J. Visser, J.A. van der Vliet, C.J. Vlijmen - van Keulen, H.G. Voesten, R. Voorhoeve, A.W. Vos, B. de Vos, G.A. Vos, B.H. Vriens, Vriens PW, A.C. de Vries, J.P. de Vries, M. de Vries, C. van der Waal, E.J. Waasdorp, B.M. Wallis de Vries, L.A. van Walraven, J.L. van Wanroij, M.C. Warlé, V. van Weel, A.M. van Well, G.M. Welten, R.J. Welten, J.J. Wever, A.M. Wiersema, O.R. Wikkeling, W.I. Willaert, J. Wille, M.C. Willems, E.M. Willigendael, W. Wisselink, M.E. Witte, C.H. Wittens, I.C. Wolf-de Jonge, O. Yazar, C.J. Zeebregts, M.L. van Zeeland, Surgery, ACS - Atherosclerosis & ischemic syndromes, Multi-Modality Medical Imaging, Gastroenterology and hepatology, Pediatrics, Hematology laboratory, Obstetrics and gynaecology, Amsterdam Movement Sciences - Restoration and Development, Public and occupational health, AGEM - Digestive immunity, Amsterdam Reproduction & Development (AR&D), ACS - Microcirculation, ACS - Diabetes & metabolism, RS: CAPHRI - R5 - Optimising Patient Care, and Epidemiologie

Subjects
Male, medicine.medical_specialty, Time Factors, SURGERY, Aortic Rupture, UT-Hybrid-D, 030204 cardiovascular system & hematology, Logistic regression, Risk Assessment, Decision Support Techniques, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Electronic Health Records, Humans, Medicine, Prospective Studies, Registries, Prospective cohort study, Aged, Netherlands, Aged, 80 and over, ABDOMINAL AORTIC-ANEURYSM, Medical Audit, business.industry, MORTALITY, Glasgow Coma Scale, Reproducibility of Results, General Medicine, medicine.disease, Comorbidity, Abdominal aortic aneurysm, n/a OA procedure, ERA, MODEL, Treatment Outcome, Predictive value of tests, Emergency medicine, Female, Cardiology and Cardiovascular Medicine, business, Risk assessment, Vascular Surgical Procedures, Aortic Aneurysm, Abdominal, Abdominal surgery
Abstract

Background: To compare hospital outcomes of aortic aneurysm surgery, casemix correction for preoperative variables is essential. Most of these variables can be deduced from mortality risk prediction models. Our aim was to identify the optimal set of preoperative variables associated with mortality to establish a relevant and efficient casemix model.Methods: All patients prospectively registered between 2013 and 2016 in the Dutch Surgical Aneurysm Audit (DSAA) were included for the analysis. After multiple imputation for missing variables, predictors for mortality following univariable logistic regression were analyzed in a manual backward multivariable logistic regression model and compared with three standard mortality risk prediction models: Glasgow Aneurysm Score (GAS, mainly clinical parameters), Vascular Biochemical and Haematological Outcome Model (VBHOM, mainly laboratory parameters), and Dutch Aneurysm Score (DAS, both clinical and laboratory parameters). Discrimination and calibration were tested and considered good with a C-statistic > 0.8 and Hosmer-Lemeshow (H-L) P > 0.05.Results: There were 12,401 patients: 9,537 (76.9%) elective patients (EAAA), 913 (7.4%) acute symptomatic patients (SAAA), and 1,951 (15.7%) patients with acute rupture (RAAA). Overall postoperative mortality was 6.5%; 1.8% after EAAA surgery, 6.6% after SAAA, and 29.6% after RAAA surgery. The optimal set of independent variables associated with mortality was a mix of clinical and laboratory parameters: gender, age, pulmonary comorbidity, operative setting, creatinine, aneurysm size, hemoglobin, Glasgow coma scale, electrocardiography, and systolic blood pressure (C-statistic 0.871). External validation overall of VBHOM, DAS, and GAS revealed C-statistics of 0.836, 0.782, and 0.761, with an H-L of 0.028, 0.00, and 0.128, respectively.Conclusions: The optimal set of variables for casemix correction in the DSAA comprises both clinical and laboratory parameters, which can be collected easily from electronic patient files and will lead to an efficient casemix model.

Published
2019
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3. National Numbers of Secondary Aortic Reinterventions after Primary Abdominal Aortic Aneurysm Surgery from the Dutch Surgical Aneurysm Audit

Author

Eleonora G. Karthaus, Anco Vahl, Bernard H.P. Elsman, Michel W.J.M. Wouters, Gert J. de Borst, Jaap F. Hamming, P.J. Van den Akker, G.J. Akkersdijk, G.P. Akkersdijk, W.L. Akkersdijk, M.G. van Andringa de Kempenaer, C.H. Arts, J.A. Avontuur, O.J. Bakker, R. Balm, W.B. Barendregt, J.A. Bekken, M.H. Bender, B.L. Bendermacher, M. van den Berg, P. Berger, R.J. Beuk, J.D. Blankensteijn, R.J. Bleker, J.J. Blok, A.S. Bode, M.E. Bodegom, K.E. van der Bogt, A.P. Boll, M.H. Booster, B.L. Borger van der Burg, G.J. de Borst, W.T. Bos-van Rossum, J. Bosma, J.M. Botman, L.H. Bouwman, V. Brehm, M.T. de Bruijn, J.L. de Bruin, P. Brummel, J.P. van Brussel, S.E. Buijk, M.A. Buijs, M.G. Buimer, D.H. Burger, H.C. Buscher, E. Cancrinus, P.H. Castenmiller, G. Cazander, A.M. Coester, P.H. Cuypers, J.H. Daemen, I. Dawson, J.E. Dierikx, M.L. Dijkstra, J. Diks, M.K. Dinkelman, M. Dirven, D.E. Dolmans, R.C. van Doorn, L.M. van Dortmont, J.W. Drouven, M.M. van der Eb, D. Eefting, G.J. van Eijck, J.W. Elshof, B.H. Elsman, A. van der Elst, M.I. van Engeland, R.G. van Eps, M.J. Faber, W.M. de Fijter, B. Fioole, T.M. Fokkema, F.A. Frans, W.M. Fritschy, P.H. Fung Kon Jin, R.H. Geelkerken, W.B. van Gent, G.J. Glade, B. Govaert, R.P. Groenendijk, H.G. de Groot, R.F. van den Haak, E.F. de Haan, G.F. Hajer, J.F. Hamming, E.S. van Hattum, C.E. Hazenberg, P.P. Hedeman Joosten, J.N. Helleman, L.G. van der Hem, J.M. Hendriks, J.A. van Herwaarden, J.M. Heyligers, J.W. Hinnen, R.J. Hissink, G.H. Ho, P.T. den Hoed, M.T. Hoedt, F. van Hoek, R. Hoencamp, W.H. Hoffmann, W. Hogendoorn, A.W. Hoksbergen, E.J. Hollander, M. Hommes, C.J. Hopmans, L.C. Huisman, R.G. Hulsebos, K.M. Huntjens, M.M. Idu, M.J. Jacobs, M.F. van der Jagt, J.R. Jansbeken, R.J. Janssen, H.H. Jiang, S.C. de Jong, T.A. Jongbloed-Winkel, V. Jongkind, M.R. Kapma, B.P. Keller, A. Khodadade Jahrome, J.K. Kievit, P.L. Klemm, P. Klinkert, N.A. Koedam, M.J. Koelemaij, J.L. Kolkert, G.G. Koning, O.H. Koning, R. Konings, A.G. Krasznai, R.M. Krol, R.H. Kropman, R.R. Kruse, L. van der Laan, M.J. van der Laan, J.H. van Laanen, G.W. van Lammeren, D.A. Lamprou, J.H. Lardenoye, G.J. Lauret, B.J. Leenders, D.A. Legemate, V.J. Leijdekkers, M.S. Lemson, M.M. Lensvelt, M.A. Lijkwan, R.C. Lind, F.T. van der Linden, P.F. Liqui Lung, M.J. Loos, M.C. Loubert, K.M. van de Luijtgaarden, D.E. Mahmoud, C.G. Manshanden, E.C. Mattens, R. Meerwaldt, B.M. Mees, G.C. von Meijenfeldt, T.P. Menting, R. Metz, R.C. Minnee, J.C. de Mol van Otterloo, M.J. Molegraaf, Y.C. Montauban van Swijndregt, M.J. Morak, R.H. van de Mortel, W. Mulder, S.K. Nagesser, C.C. Naves, J.H. Nederhoed, A.M. Nevenzel-Putters, A.J. de Nie, D.H. Nieuwenhuis, J. Nieuwenhuizen, R.C. van Nieuwenhuizen, D. Nio, V.J. Noyez, A.P. Oomen, B.I. Oranen, J. Oskam, H.W. Palamba, A.G. Peppelenbosch, A.S. van Petersen, B.J. Petri, M.E. Pierie, A.J. Ploeg, R.A. Pol, E.D. Ponfoort, I.C. Post, P.P. Poyck, A. Prent, S. ten Raa, J.T. Raymakers, M. Reichart, B.L. Reichmann, M.M. Reijnen, J.A. de Ridder, A. Rijbroek, M.J. van Rijn, R.A. de Roo, E.V. Rouwet, B.R. Saleem, P.B. Salemans, M.R. van Sambeek, M.G. Samyn, H.P. van't Sant, J. van Schaik, P.M. van Schaik, D.M. Scharn, M.R. Scheltinga, A. Schepers, P.M. Schlejen, F.J. Schlosser, F.P. Schol, V.P. Scholtes, O. Schouten, M.A. Schreve, G.W. Schurink, C.J. Sikkink, A. te Slaa, H.J. Smeets, L. Smeets, R.R. Smeets, A.A. de Smet, P.C. Smit, T.M. Smits, M.G. Snoeijs, A.O. Sondakh, M.J. Speijers, T.J. van der Steenhoven, S.M. van Sterkenburg, D.A. Stigter, R.A. Stokmans, R.P. Strating, G.N. Stultiëns, J.E. Sybrandy, J.A. Teijink, B.J. Telgenkamp, M. Teraa, M.J. Testroote, T. Tha-In, R.M. The, W.J. Thijsse, I. Thomassen, I.F. Tielliu, R.B. van Tongeren, R.J. Toorop, E. Tournoij, M. Truijers, K. Türkcan, R.P. Tutein Nolthenius, Ç. Ünlü, R.H. Vaes, A.A. Vafi, A.C. Vahl, E.J. Veen, H.T. Veger, M.G. Veldman, S. Velthuis, H.J. Verhagen, B.A. Verhoeven, C.F. Vermeulen, E.G. Vermeulen, B.P. Vierhout, R.J. van der Vijver-Coppen, M.J. Visser, J.A. van der Vliet, C.J. Vlijmen-van Keulen, R. Voorhoeve, J.R. van der Vorst, A.W. Vos, B. de Vos, C.G. Vos, G.A. Vos, M.T. Voute, B.H. Vriens, P.W. Vriens, A.C. de Vries, D.K. de Vries, J.P. de Vries, M. de Vries, C. van der Waal, E.J. Waasdorp, W. de Vries, L.A. van Walraven, J.L. van Wanroij, M.C. Warlé, W. van de Water, V. van Weel, A.M. van Well, G.M. Welten, R.J. Welten, J.J. Wever, A.M. Wiersema, O.R. Wikkeling, W.I. Willaert, J. Wille, M.C. Willems, E.M. Willigendael, E.D. Wilschut, W. Wisselink, M.E. Witte, C.H. Wittens, C.Y. Wong, R. Wouda, O. Yazar, K.K. Yeung, C.J. Zeebregts, M.L. van Zeeland, Surgery, ACS - Atherosclerosis & ischemic syndromes, Pathology, VU University medical center, Pediatrics, Dermatology, ACS - Microcirculation, ACS - Diabetes & metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Multi-Modality Medical Imaging, Technical Medicine, RS: CAPHRI - R5 - Optimising Patient Care, and Epidemiologie

Subjects
Male, Time Factors, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], UT-Hybrid-D, EVAR TRIAL 1, OPEN REPAIR, 030204 cardiovascular system & hematology, Endovascular aneurysm repair, 030218 nuclear medicine & medical imaging, Postoperative Complications, 0302 clinical medicine, LONG-TERM OUTCOMES, Risk Factors, FAILURE, Registries, skin and connective tissue diseases, Netherlands, Aged, 80 and over, Medical Audit, Endovascular Procedures, General Medicine, EDITORS CHOICE, Abdominal aortic aneurysm, Treatment Outcome, Cohort, cardiovascular system, INSTRUCTIONS, Female, Cardiology and Cardiovascular Medicine, Reoperation, medicine.medical_specialty, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, Aneurysm, medicine, Humans, Aged, Surgical repair, business.industry, MORTALITY, fungi, Stent, ENDOVASCULAR REPAIR, Odds ratio, medicine.disease, Confidence interval, Surgery, body regions, business, SYSTEM, Aortic Aneurysm, Abdominal
Abstract

Contains fulltext : 226469.pdf (Publisher’s version ) (Open Access) BACKGROUND: Long-term secondary aortic reinterventions (SARs) can be a sign of (lack of) effectiveness of abdominal aortic aneurysm (AAA) surgery. This study provides insight into the national number of SARs after primary AAA repair by endovascular aneurysm repair (EVAR) or by open surgical repair in the Netherlands. METHODS: Observational study included all patients undergoing SAR between 2016 and 2017, registered in the compulsory Dutch Surgical Aneurysm Audit (DSAA). The DSAA started in 2013, SARs are registered from 2016. Characteristics of SAR and postoperative outcomes (mortality/complications) were analyzed, stratified by urgency of SAR. Data of SARs were merged with data of their preceded primary AAA repair, registered in the DSAA after January 2013. In these patients undergoing SAR, treatment characteristics of the preceded primary AAA repair were additionally described, with focus on differences between stent grafts. RESULTS: Between 2016 and 2017, 691 patients underwent SAR, this concerned 9.3% of all AAA procedures (infrarenal/juxtarenal/suprarenal) in the Netherlands (77% elective/11% acute symptomatic/12% ruptured). Endoleak (60%) was the most frequent indication for SAR. SARs were performed with EVAR in 66%. Postoperative mortalities after SAR were 3.4%, 11%, and 29% in elective, acute symptomatic, and ruptured patients, respectively. In 26% (n = 181) of the patients undergoing SAR their primary AAA repair was performed after January 2013 and data of primary and SAR procedures could be merged. In 93% (n = 136), primary AAA repair was EVAR. Endografts primarily used were nitinol/polyester (62%), nitinol/polytetrafluoroethylene (8%), endovascular sealing (21%), and others (9%), compared with their national market share of 76% (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.38-0.71), 15% (OR, 0.50; CI, 0.29-0.89), 4.9% (OR, 5.04; CI, 3.44-7.38), and 4.1% (OR, 2.81; CI, 1.66-4.74), respectively. CONCLUSIONS: In the Netherlands, about one-tenth of the annual AAA procedures concerns an SAR. A quarter of this cohort had an SAR within 1-5 years after their primary AAA repair. Most SARs followed after primary EVAR procedures, in which an overrepresentation of endovascular sealing grafts was seen. Postoperative mortality after SAR is comparable with primary AAA repair.

Published
2020
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4. A Composite Measure for Quality of Care in Patients with Symptomatic Carotid Stenosis Using Textbook Outcome

Author

Laurien S. Kuhrij, Eleonora G. Karthaus, Anco C. Vahl, Martine C.M. Willems, Jan W. Elshof, Gert J. de Borst, P.J. Van den Akker, G.J. Akkersdijk, G.P. Akkersdijk, W.L. Akkersdijk, M.G. van Andringa de Kempenaer, C.H. Arts, J.A. Avontuur, O.J. Bakker, R. Balm, W.B. Barendregt, J.A. Bekken, M.H. Bender, B.L. Bendermacher, M. van den Berg, P. Berger, R.J. Beuk, J.D. Blankensteijn, R.J. Bleker, J.J. Blok, A.S. Bode, M.E. Bodegom, K.E. van der Bogt, A.P. Boll, M.H. Booster, B.L. Borger van der Burg, G.J. de Borst, W.T. Bos-van Rossum, J. Bosma, J.M. Botman, L.H. Bouwman, V. Brehm, M.T. de Bruijn, J.L. de Bruin, P. Brummel, J.P. van Brussel, S.E. Buijk, M.A. Buijs, M.G. Buimer, D.H. Burger, H.C. Buscher, E. Cancrinus, P.H. Castenmiller, G. Cazander, A.M. Coester, P.H. Cuypers, J.H. Daemen, I. Dawson, J.E. Dierikx, M.L. Dijkstra, J. Diks, M.K. Dinkelman, M. Dirven, D.E. Dolmans, R.C. van Doorn, L.M. van Dortmont, J.W. Drouven, M.M. van der Eb, D. Eefting, G.J. van Eijck, J.W. Elshof, B.H. Elsman, A. van der Elst, M.I. van Engeland, R.G. van Eps, M.J. Faber, W.M. de Fijter, B. Fioole, T.M. Fokkema, F.A. Frans, W.M. Fritschy, P.H. Fung Kon Jin, R.H. Geelkerken, W.B. van Gent, G.J. Glade, B. Govaert, R.P. Groenendijk, H.G. de Groot, R.F. van den Haak, E.F. de Haan, G.F. Hajer, J.F. Hamming, E.S. van Hattum, C.E. Hazenberg, P.P. Hedeman Joosten, J.N. Helleman, L.G. van der Hem, J.M. Hendriks, J.A. van Herwaarden, J.M. Heyligers, J.W. Hinnen, R.J. Hissink, G.H. Ho, P.T. den Hoed, M.T. Hoedt, F. van Hoek, R. Hoencamp, W.H. Hoffmann, W. Hogendoorn, A.W. Hoksbergen, E.J. Hollander, M. Hommes, C.J. Hopmans, L.C. Huisman, R.G. Hulsebos, K.M. Huntjens, M.M. Idu, M.J. Jacobs, M.F. van der Jagt, J.R. Jansbeken, R.J. Janssen, H.H. Jiang, S.C. de Jong, T.A. Jongbloed-Winkel, V. Jongkind, M.R. Kapma, B.P. Keller, A. Khodadade Jahrome, J.K. Kievit, P.L. Klemm, P. Klinkert, N.A. Koedam, M.J. Koelemaij, J.L. Kolkert, G.G. Koning, O.H. Koning, R. Konings, A.G. Krasznai, R.M. Krol, R.H. Kropman, R.R. Kruse, L. van der Laan, M.J. van der Laan, J.H. van Laanen, G.W. van Lammeren, D.A. Lamprou, J.H. Lardenoye, G.J. Lauret, B.J. Leenders, D.A. Legemate, V.J. Leijdekkers, M.S. Lemson, M.M. Lensvelt, M.A. Lijkwan, R.C. Lind, F.T. van der Linden, P.F. Liqui Lung, M.J. Loos, M.C. Loubert, K.M. van de Luijtgaarden, D.E. Mahmoud, C.G. Manshanden, E.C. Mattens, R. Meerwaldt, B.M. Mees, G.C. von Meijenfeldt, T.P. Menting, R. Metz, R.C. Minnee, J.C. de Mol van Otterloo, M.J. Molegraaf, Y.C. Montauban van Swijndregt, M.J. Morak, R.H. van de Mortel, W. Mulder, S.K. Nagesser, C.C. Naves, J.H. Nederhoed, A.M. Nevenzel-Putters, A.J. de Nie, D.H. Nieuwenhuis, J. Nieuwenhuizen, R.C. van Nieuwenhuizen, D. Nio, V.J. Noyez, A.P. Oomen, B.I. Oranen, J. Oskam, H.W. Palamba, A.G. Peppelenbosch, A.S. van Petersen, B.J. Petri, M.E. Pierie, A.J. Ploeg, R.A. Pol, E.D. Ponfoort, I.C. Post, P.P. Poyck, A. Prent, S. ten Raa, J.T. Raymakers, M. Reichart, B.L. Reichmann, M.M. Reijnen, J.A. de Ridder, A. Rijbroek, M.J. van Rijn, R.A. de Roo, E.V. Rouwet, B.R. Saleem, P.B. Salemans, M.R. van Sambeek, M.G. Samyn, H.P. van ’t Sant, J. van Schaik, P.M. van Schaik, D.M. Scharn, M.R. Scheltinga, A. Schepers, P.M. Schlejen, F.J. Schlosser, F.P. Schol, V.P. Scholtes, O. Schouten, M.A. Schreve, G.W. Schurink, C.J. Sikkink, A. te Slaa, H.J. Smeets, L. Smeets, R.R. Smeets, A.A. de Smet, P.C. Smit, T.M. Smits, M.G. Snoeijs, A.O. Sondakh, M.J. Speijers, T.J. van der Steenhoven, S.M. van Sterkenburg, D.A. Stigter, R.A. Stokmans, R.P. Strating, G.N. Stultiëns, J.E. Sybrandy, J.A. Teijink, B.J. Telgenkamp, M. Teraa, M.J. Testroote, T. Tha-In, R.M. The, W.J. Thijsse, I. Thomassen, I.F. Tielliu, R.B. van Tongeren, R.J. Toorop, E. Tournoij, M. Truijers, K. Türkcan, R.P. Tutein Nolthenius, Ç. Ünlü, R.H. Vaes, A.A. Vafi, A.C. Vahl, E.J. Veen, H.T. Veger, M.G. Veldman, S. Velthuis, H.J. Verhagen, B.A. Verhoeven, C.F. Vermeulen, E.G. Vermeulen, B.P. Vierhout, R.J. van der Vijver-Coppen, M.J. Visser, J.A. van der Vliet, C.J. Vlijmen - van Keulen, R. Voorhoeve, J.R. van der Vorst, A.W. Vos, B. de Vos, C.G. Vos, G.A. Vos, M.T. Voute, B.H. Vriens, P.W. Vriens, A.C. de Vries, D.K. de Vries, J.P. de Vries, M. de Vries, C. van der Waal, E.J. Waasdorp, B.M. Wallis de Vries, L.A. van Walraven, J.L. van Wanroij, M.C. Warlé, W. van de Water, V. van Weel, A.M. van Well, G.M. Welten, R.J. Welten, J.J. Wever, A.M. Wiersema, O.R. Wikkeling, W.I. Willaert, J. Wille, M.C. Willems, E.M. Willigendael, E.D. Wilschut, W. Wisselink, M.E. Witte, C.H. Wittens, C.Y. Wong, R. Wouda, O. Yazar, K.K. Yeung, C.J. Zeebregts, M.L. van Zeeland, Surgery, ACS - Atherosclerosis & ischemic syndromes, Pathology, VU University medical center, Pediatrics, ACS - Microcirculation, ACS - Diabetes & metabolism, Multi-Modality Medical Imaging, Technical Medicine, RS: CAPHRI - R5 - Optimising Patient Care, Epidemiologie, Graduate School, ANS - Neurovascular Disorders, APH - Methodology, and APH - Quality of Care

Subjects
Male, Time Factors, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Psychological intervention, UT-Hybrid-D, Carotid endarterectomy, 030204 cardiovascular system & hematology, 030230 surgery, Logistic regression, 0302 clinical medicine, Risk Factors, Carotid Stenosis, Registries, Stroke, Netherlands, Outcome, Aged, 80 and over, RISK, Endarterectomy, Carotid, ENDARTERECTOMY, Middle Aged, Outcome and Process Assessment, Health Care, Treatment Outcome, Ischemic Attack, Transient, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Funnel plot, Postoperative Hemorrhage, Patient Readmission, 03 medical and health sciences, Case mix index, Internal medicine, medicine, Humans, HOSPITAL QUALITY, Healthcare Disparities, Aged, Quality Indicators, Health Care, business.industry, Quality of care, 22/2 OA procedure, Length of Stay, medicine.disease, Comorbidity, Cranial Nerve Diseases, Stenosis, Surgery, business
Abstract

Contains fulltext : 226467.pdf (Publisher’s version ) (Closed access) OBJECTIVE: Composite measures may better objectify hospital performance than individual outcome measures (IOM). Textbook outcome (TO) is an outcome measure achieved for an individual patient when all undesirable outcomes are absent. The aim of this study was to assess TO as an additional outcome measure to evaluate quality of care in symptomatic patients treated by carotid endarterectomy (CEA). METHODS: All symptomatic patients treated by CEA in 2018, registered in the Dutch Audit for Carotid Interventions, were included. TO was defined as a composite of the absence of 30 day mortality, neurological events (any stroke or transient ischaemic attack [TIA]), cranial nerve deficit, haemorrhage, 30 day readmission, prolonged length of stay (LOS; > 5 days) and any other surgical complication. Multivariable logistic regression was used to identify covariables associated with achieving TO, which were used for casemix adjustment for hospital comparison. For each hospital, an observed vs. expected number of events ratio (O/E ratio) was calculated and plotted in a funnel plot with 95% control limits. RESULTS: In total, 70.7% of patients had a desired outcome within 30 days after CEA and therefore achieved TO. Prolonged LOS was the most common parameter (85%) and mortality the least common (1.1%) for not achieving TO. Covariates associated with achieving TO were younger age, the absence of pulmonary comorbidity, higher haemoglobin levels, and TIA as index event. In the case mix adjusted funnel plot, the O/E ratios between hospitals ranged between 0.63 and 1.27, with two hospitals revealing a statistically significantly lower rate of TO (with O/E ratios of 0.63 and 0.66). CONCLUSION: In the Netherlands, most patients treated by CEA achieve TO. Variation between hospitals in achieving TO might imply differences in performance. TO may be used as an additive to the pre-existing IOM, especially in surgical care with low baseline risk such as CEA.

Published
2020
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5. Failure to Rescue - a Closer Look at Mortality Rates Has No Added Value for Hospital Comparisons but Is Useful for Team Quality Assessment in Abdominal Aortic Aneurysm Surgery in The Netherlands

Author

Niki Lijftogt, Eleonora G. Karthaus, Anco Vahl, Erik W. van Zwet, Esmee M. van der Willik, Robertus A.E.M. Tollenaar, Jaap F. Hamming, Michel W.J.M. Wouters, L.H. Van den Akker, P.J. Van den Akker, G.J. Akkersdijk, G.P. Akkersdijk, W.L. Akkersdijk, M.G. van Andringa de Kempenaer, C.H. Arts, J.A. Avontuur, J.G. Baal, O.J. Bakker, R. Balm, W.B. Barendregt, M.H. Bender, B.L. Bendermacher, M. van den Berg, P. Berger, R.J. Beuk, J.D. Blankensteijn, R.J. Bleker, J.H. Bockel, M.E. Bodegom, K.E. Bogt, A.P. Boll, M.H. Booster, B.L. Borger van der Burg, G.J. de Borst, W.T. Bos-van Rossum, J. Bosma, J.M. Botman, L.H. Bouwman, J.C. Breek, V. Brehm, M.J. Brinckman, T.H. van den Broek, H.L. Brom, M.T. de Bruijn, J.L. de Bruin, P. Brummel, J.P. van Brussel, S.E. Buijk, M.G. Buimer, D.H. Burger, H.C. Buscher, G. den Butter, E. Cancrinus, P.H. Castenmiller, G. Cazander, H.M. Coveliers, P.H. Cuypers, J.H. Daemen, I. Dawson, A.F. Derom, A.R. Dijkema, J. Diks, M.K. Dinkelman, M. Dirven, D.E. Dolmans, R.C. van Doorn, L.M. van Dortmont, M.M. van der Eb, D. Eefting, G.J. van Eijck, J.W. Elshof, B.H. Elsman, A. van der Elst, M.I. van Engeland, R.G. van Eps, M.J. Faber, W.M. de Fijter, B. Fioole, W.M. Fritschy, R.H. Geelkerken, W.B. van Gent, G.J. Glade, B. Govaert, R.P. Groenendijk, H.G. de Groot, R.F. van den Haak, E.F. de Haan, G.F. Hajer, J.F. Hamming, E.S. van Hattum, C.E. Hazenberg, P.P. Hedeman Joosten, J.N. Helleman, L.G. van der Hem, J.M. Hendriks, J.A. van Herwaarden, J.M. Heyligers, J.W. Hinnen, R.J. Hissink, G.H. Ho, P.T. den Hoed, M.T. Hoedt, F. van Hoek, R. Hoencamp, W.H. Hoffmann, A.W. Hoksbergen, E.J. Hollander, L.C. Huisman, R.G. Hulsebos, K.M. Huntjens, M.M. Idu, M.J. Jacobs, M.F. van der Jagt, J.R. Jansbeken, R.J. Janssen, H.H. Jiang, S.C. de Jong, V. Jongkind, M.R. Kapma, B.P. Keller, A. Khodadade Jahrome, J.K. Kievit, P.L. Klemm, P. Klinkert, B. Knippenberg, N.A. Koedam, M.J. Koelemaij, J.L. Kolkert, G.G. Koning, O.H. Koning, A.G. Krasznai, R.M. Krol, R.H. Kropman, R.R. Kruse, L. van der Laan, M.J. van der Laan, J.H. van Laanen, J.H. Lardenoye, J.A. Lawson, D.A. Legemate, V.J. Leijdekkers, M.S. Lemson, M.M. Lensvelt, M.A. Lijkwan, R.C. Lind, F.T. van der Linden, P.F. Liqui Lung, M.J. Loos, M.C. Loubert, D.E. Mahmoud, C.G. Manshanden, E.C. Mattens, R. Meerwaldt, B.M. Mees, R. Metz, R.C. Minnee, J.C. de Mol van Otterloo, F.L. Moll, Y.C. Montauban van Swijndregt, M.J. Morak, R.H. van de Mortel, W. Mulder, S.K. Nagesser, C.C. Naves, J.H. Nederhoed, A.M. Nevenzel-Putters, A.J. de Nie, D.H. Nieuwenhuis, J. Nieuwenhuizen, R.C. van Nieuwenhuizen, D. Nio, A.P. Oomen, B.I. Oranen, J. Oskam, H.W. Palamba, A.G. Peppelenbosch, A.S. van Petersen, T.F. Peterson, B.J. Petri, M.E. Pierie, A.J. Ploeg, R.A. Pol, E.D. Ponfoort, P.P. Poyck, A. Prent, S. ten Raa, J.T. Raymakers, M. Reichart, B.L. Reichmann, M.M. Reijnen, A. Rijbroek, M.J. van Rijn, R.A. de Roo, E.V. Rouwet, C.G. Rupert, B.R. Saleem, M.R. van Sambeek, M.G. Samyn, H.P. van ’t Sant, J. van Schaik, P.M. van Schaik, D.M. Scharn, M.R. Scheltinga, A. Schepers, P.M. Schlejen, F.J. Schlosser, F.P. Schol, O. Schouten, M.H. Schreinemacher, M.A. Schreve, G.W. Schurink, C.J. Sikkink, M.P. Siroen, A. te Slaa, H.J. Smeets, L. Smeets, A.A. de Smet, P. de Smit, P.C. Smit, T.M. Smits, M.G. Snoeijs, A.O. Sondakh, T.J. van der Steenhoven, S.M. van Sterkenburg, D.A. Stigter, H. Stigter, R.P. Strating, G.N. Stultiëns, J.E. Sybrandy, J.A. Teijink, B.J. Telgenkamp, M.J. Testroote, R.M. The, W.J. Thijsse, I.F. Tielliu, R.B. van Tongeren, R.J. Toorop, J.H. Tordoir, E. Tournoij, M. Truijers, K. Türkcan, R.P. Tutein Nolthenius, Ç. Ünlü, A.A. Vafi, A.C. Vahl, E.J. Veen, H.T. Veger, M.G. Veldman, H.J. Verhagen, B.A. Verhoeven, C.F. Vermeulen, E.G. Vermeulen, B.P. Vierhout, M.J. Visser, J.A. van der Vliet, C.J. Vlijmen-van Keulen, H.G. Voesten, R. Voorhoeve, A.W. Vos, B. de Vos, G.A. Vos, B.H. Vriens, P.W. Vriens, A.C. de Vries, J.P. de Vries, M. de Vries, C. van der Waal, E.J. Waasdorp, B.M. Wallis de Vries, L.A. van Walraven, J.L. van Wanroij, M.C. Warlé, V. van Weel, A.M. van Well, G.M. Welten, R.J. Welten, J.J. Wever, A.M. Wiersema, O.R. Wikkeling, W.I. Willaert, J. Wille, M.C. Willems, E.M. Willigendael, W. Wisselink, M.E. Witte, C.H. Wittens, I.C. Wolf-de Jonge, O. Yazar, C.J. Zeebregts, M.L. van Zeeland, RS: CAPHRI - R5 - Optimising Patient Care, Epidemiologie, Surgery, Pediatrics, ACS - Atherosclerosis & ischemic syndromes, Pathology, Dermatology, ACS - Microcirculation, AII - Inflammatory diseases, and AGEM - Digestive immunity

Subjects
Clinical audit, medicine.medical_specialty, Funnel plot, TO-RESCUE, Time Factors, Failure to rescue, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], MODELS, 030204 cardiovascular system & hematology, 030230 surgery, PREVENTABILITY, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Aneurysm, medicine, Humans, Hospital Mortality, SURGICAL COLORECTAL AUDIT, Netherlands, TRAUMA, REPAIR, RISK, Surgical outcome, OUTCOMES, medicine.diagnostic_test, business.industry, Mortality rate, Endovascular Procedures, Glasgow Coma Scale, CARE, medicine.disease, Quality Improvement, CANCER, Hospitals, Abdominal aortic aneurysm, Surgery, Composite outcome measures, Elective Surgical Procedures, Cardiology and Cardiovascular Medicine, business, Electrocardiography, Aortic Aneurysm, Abdominal
Abstract

Objectives: Failure to rescue (FTR) is a composite quality indicator, defined as the proportion of deceased patients following major complications. The aims of this study were to compare FTR with mortality for hospital comparisons in abdominal aortic aneurysm (AAA) surgery in The Netherlands and investigate hospital volume and associated factors.Methods: Patients prospectively registered between 2013 and 2015 in the Dutch Surgical Aneurysm Audit (DSAA) were analysed. FTR was analysed for AAA patients and subgroups elective (EAAA) and acute (AAAA; symptomatic or ruptured) aneurysms. Variables and hospital volume were analysed by uni- and multivariable regression analysis. Adjusted hospital comparisons for mortality, major complications, and FTR were presented in funnel plots. Isomortality lines were constructed when presenting FTR and major complication rates.Results: A total of 9258 patients were analysed in 61 hospitals: 7149 EAAA patients (77.2%) and 2109 AAAA patients (22.8%). There were 2785 (30.1%) patients with complications (unadjusted range 5-65% per hospital): 2161 (77.6%) with major and 624 (28.4%) patients with minor complications. Overall mortality was 6.6% (adjusted range 0-16% per hospital) and FTR was 28.4% (n = 613) (adjusted range 0-60% per hospital). Glasgow Coma Scale, age, pulse, creatinine, electrocardiography, and operative setting were independently associated with FTR. Hospital volume was not associated with FTR. In AAAA patients hospital volume was significantly associated with a lower adjusted major complication and mortality rate (OR 0.62, 95% CI 0.49-0.78; and 0.64, 95% CI 0.48-0.87). Four hospitals had a significant lower adjusted FTR with different major complication rates on different isomortality lines.Conclusions: There was more variation in FTR than in mortality between hospitals. FTR identified the same best performing hospitals as for mortality and therefore was of limited additional value in measuring quality of care for AAA surgery. FTR can be used for internal quality improvement with major complications in funnel plots and diagrams with isomortality lines. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

Published
2018
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