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The need for quality assurance in vascular surgery
F J Veith1, J Goldsmith, R P Leather
1Division of Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York.
Journal of Vascular Surgery
|April 1, 1991
Summary
Vascular surgery quality assurance is vital. Higher surgeon and hospital volume for unruptured abdominal aortic aneurysm repair significantly reduces operative mortality rates, even after adjusting for patient factors.
Area of Science:
- Vascular Surgery
- Health Services Research
- Quality Assurance
Background:
- Variability in unruptured abdominal aortic aneurysm (AAA) operative death rates suggests quality of care influences outcomes.
- Controlling for patient factors allows for assessment of quality-related mortality differences.
Purpose of the Study:
- To determine the impact of surgeon and hospital volume on operative mortality rates for unruptured AAA repair.
- To assess the need for quality assurance in vascular surgery.
Main Methods:
- Analysis of 3570 unruptured AAA repair cases in New York State (1985-1987).
- Comparison of operative mortality rates based on surgeon and hospital annual procedure volume.
- Statistical adjustment for patient age, illness severity, comorbidities, and admission status.
Main Results:
- Surgeons performing >26 AAA repairs/year had 6% mortality vs. 10% for those doing 1-5/year (p<0.0001).
- Hospitals performing >38 AAA repairs/year had 5% mortality vs. 14% for those doing 1-5/year (p<0.0001).
- Adjusted mortality remained significantly lower for high-volume surgeons (4% vs. 9%) and hospitals (5% vs. 12%).
Conclusions:
- Higher surgeon and hospital procedural volume is associated with significantly lower operative mortality for unruptured AAA repair.
- Volume-outcome relationships highlight the importance of quality assurance and potential for specialized centers.
- Findings support the need for quality metrics and potential centralization of complex vascular procedures.