The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands

Karthaus, Eleonora G.; Vahl, A.C.; Kuhrij, Laurien S.; Elsman, B.H.P.; Geelkerken, Robert H.; Wouters, Michel W. J. M.; Hamming, Jaap F.; Borst, Gert J. de

doi:10.1016/j.ejvs.2018.05.030

Cited by 19 publications

(22 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It was founded in 2011 after colorectal surgeons initiated the Dutch Surgical Colorectal Audit (DSCA) [ 20 ]. At present, 22 nationwide clinical audits are facilitated by DICA [ 21 – 24 ].…”

Section: Methodsmentioning

confidence: 99%

The Dutch Hip Fracture Audit: evaluation of the quality of multidisciplinary hip fracture care in the Netherlands

Voeten

Arends²,

Wouters

et al. 2019

Arch Osteoporos

View full text Add to dashboard Cite

Summary The nationwide Dutch Hip Fracture Audit (DHFA) is initiated to improve the quality of hip fracture care by providing insight into the actual quality of hip fracture care in daily practice. The baseline results demonstrate variance in practice, providing potential starting points to improve the quality of care. Purpose The aim of this study is to describe the development and initiation of the DHFA. The secondary aim is to describe the hip fracture care in the Netherlands at the start of the audit and to assess whether there are differences in processes at baseline between hospitals. Methods Eighty-one hospitals were asked to register their consecutive hip fracture patients since April 2016. In 2017, the first full calendar year, the case ascertainment was determined at audit level. Three quality indicators were used to describe and assess the care process at audit and hospital level: the proportion of completed variables at discharge and at 3 months after operation, time to surgery and orthogeriatric management. Results Sixty (74%) hospitals documented 14,274 patients in the DHFA by December 2017. In 2017, the case ascertainment was 58% and the average proportion of completed variables was 77%: 91% at discharge and 30% at 3 months. The median time to operation was 18 h (IQR 7–23) for American Society of Anesthesiologists score (ASA) 1–2 patients and 21 h (IQR 13–27) for ASA 3–4 patients. Of patients aged 70 years and older, 78% received orthogeriatric management. At hospital level, all three indicators showed significant practice variance. Conclusion Not all hospitals participate in the DHFA, and the data gathering process needs to be further optimized. However, the baseline results demonstrate an apparent variance in hip fracture practice between hospitals in the Netherlands, providing potential starting points to improve the quality of hip fracture care.

show abstract

Section: Methodsmentioning

confidence: 99%

The Dutch Hip Fracture Audit: evaluation of the quality of multidisciplinary hip fracture care in the Netherlands

Voeten

Arends²,

Wouters

et al. 2019

Arch Osteoporos

View full text Add to dashboard Cite

show abstract

“…The audit uses indicators to measure the quality of care and provide a national benchmark. 7 The percentage of symptomatic patients treated within 14 days of their first consultation at any hospital is a quality indicator set by the Dutch Society for Vascular Surgery and enforced by the Health and Youth Care Inspectorate.…”

Section: Data Sourcementioning

confidence: 99%

Factors Associated with Hospital Dependent Delay to Carotid Endarterectomy in the Dutch Audit for Carotid Interventions

Kuhrij

Meershoek

Karthaus

et al. 2019

European Journal of Vascular and Endovascular Surgery

Self Cite

View full text Add to dashboard Cite

WHAT THIS PAPER ADDS This paper identifies factors that are associated with hospital dependent delay to carotid endarterectomy (CEA) using data from a nationwide mandatory clinical audit in the Netherlands. By establishing these factors, other hospitals can learn which patients are at risk of a longer waiting time for CEA and can evaluate their own protocol accordingly. Objectives: As the risk of a recurrent neurological event in patients with symptomatic carotid stenosis requiring carotid endarterectomy (CEA) is highest in the early phase after the first neurological event, guidelines recommend operating on these patients as soon as possible or at least within 14 days of their initial event. However, in real world practice this is often not met. The aim of this study is to identify factors that cause hospital dependent delay to CEA. Methods: All consecutive patients with symptomatic carotid stenosis undergoing CEA registered in the mandatory Dutch Audit for Carotid Interventions from January 2014 up to and including December 2017 were included in the current analysis. Univariable followed by multivariable logistic regression was used to identify independent factors associated with hospital dependent waiting time, defined as time from the first consultation at any hospital to CEA of more than 14 days. Results: A total of 8620 patients were included. The median time to CEA was 11 days (IQR 8e14). Seventy-eight per cent of patients underwent CEA within 14 days of first hospital consultation. Factors associated with a hospital dependent waiting time longer than 14 days were age (OR 0.99 per year, 95% CI 0.98e0.99), any previous CEA (OR 1.67, 95% CI 1.32e2.09), ocular symptoms as index event (OR 1.31, 95% CI 1.15e1.50), and indirect referral (OR 1.53, 95% CI 1.34e1.73). Hospital surgical volume was not identified as a factor for delay, except for the delay of indirectly referred patients where high volume hospitals reported the shortest delay. Conclusion: This cohort derived from a validated nationwide prospective audit identified younger age, previous CEA, ocular symptoms, and indirect referral as hospital dependent factors for delay. High volume hospitals had a similar hospital dependent waiting time to middle and low volume hospitals. However, high volume hospitals had more indirect referrals, implying that their logistics are more efficiently organised.

show abstract

“…20e22 In the Netherlands 75% of the symptomatic patients are operated on within two weeks. 23 Post-hoc analyses of large RCTs (The Carotid Endarterectomy Trialists Collaboration [CETC]) allows estimation of the number of strokes prevented per 1000 CEAs at five years in relation to selected clinical subgroups. 16,17,24 By using the earlier published theoretical absolute risk .…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Carotid Surgery by Subgroups: The Concept of Stroke Prevention Potential

Aro

Ijäs

Vikatmaa

et al. 2019

European Journal of Vascular and Endovascular Surgery

View full text Add to dashboard Cite

WHAT THIS PAPER ADDS Patient selection should be a key component of carotid surgery reports. A calculator was created where the presence and recentness of symptoms, sex, increasing stenosis severity, and complication rates could all be combined into a single figure. The calculator was tested on real life material and some theoretical inclusion scenarios. Single hospital treatment development over time and benchmarking between hospitals can be monitored when registered data includes these parameters, ultimately leading to improved patient selection.Objective: Considering carotid endarterectomy (CEA), reporting treatment delay, symptom status, and surgical complication rates separately gives an incomplete picture of efficacy; therefore, the aim was to combine these factors and develop a reporting standard that better describes the number of potentially prevented strokes. With a real life cohort and theoretical inclusion scenarios, the aim was to explore the stroke prevention potential of different carotid practices. Methods: Landmark studies for symptomatic and asymptomatic patients were revisited. By using published estimates of treatment effect, a simplified calculator was designed to assess the five year stroke prevention rate per 1000 CEAs (stroke prevention potential [SPP], range 0e478), including the presence and recentness of symptoms, sex, increasing stenosis severity, and complication rates. Patients operated on for carotid stenosis at Helsinki University Hospital (HUH) between 2008 and 2016 were collected from a vascular registry (HUSVASC) and categorised according to the model. The local annual complication rate was re-evaluated and added to the model. The HUH patient cohort was incorporated into the SPP model, and changes over time analysed. Finally, theoretical changes in patient selection were compared in order to explore the theoretical impact of patient selection and shortening of the delay. Results: Fifteen hundred and five symptomatic and 356 asymptomatic carotid stenoses were operated on with stroke plus death rates of 3.6% and 0.3%, respectively. The proportion of CEAs performed within two weeks of the index event increased over the follow up period, being 77% in 2016. The SPP increased from 123 in 2008 to 229 in 2016. Theoretically, 350 ischaemic strokes were prevented in the period 2008e16, with 1861 CEAs. Conclusions: National and international comparison of different CEA series is irrelevant if the inclusion criteria are not considered. A calculator that is easy to apply to large scale high quality registered data was developed and tested. SPP was found to increase over time, which is a probable sign of improved patient selection and an increased number of strokes prevented by the CEAs performed.

show abstract

The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands

Cited by 19 publications

References 25 publications

The Dutch Hip Fracture Audit: evaluation of the quality of multidisciplinary hip fracture care in the Netherlands

The Dutch Hip Fracture Audit: evaluation of the quality of multidisciplinary hip fracture care in the Netherlands

Factors Associated with Hospital Dependent Delay to Carotid Endarterectomy in the Dutch Audit for Carotid Interventions

The Efficacy of Carotid Surgery by Subgroups: The Concept of Stroke Prevention Potential

Contact Info

Product

Resources

About