TY - JOUR
T1 - The Dutch Audit of Carotid Interventions
T2 - Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands
AU - Karthaus, Eleonora G
AU - Vahl, Anco
AU - Kuhrij, Laurien S
AU - Elsman, Bernard H P
AU - Geelkerken, Robert H
AU - Wouters, Michel W J M
AU - Hamming, Jaap F
AU - de Borst, Gert J
AU - Hazenberg, CEVB
N1 - Funding Information:
The authors would like to thank all surgeons, registrars, physician assistants, and administrative nurses who registered all the patients in the DACI, as well as the Dutch Audit for Carotid Interventions group. The authors would like to thank Vanessa Leijdekkers for her critical review of the manuscript.
Publisher Copyright:
© 2018 European Society for Vascular Surgery
PY - 2018/10
Y1 - 2018/10
N2 - Background: The Dutch Audit for Carotid Interventions (DACI) registers all patients undergoing interventions for carotid artery stenosis in the Netherlands. This study describes the design of the DACI and results of patients with a symptomatic stenosis undergoing carotid endarterectomy (CEA). It aimed to evaluate variation between hospitals in process of care and (adjusted) outcomes, as well as predictors of major stroke/death after CEA. Methods: All patients with a symptomatic stenosis, who underwent CEA and were registered in the DACI between 2014 and 2016 were included in this cohort. Descriptive analyses of patient characteristics, process of care, and outcomes were performed. Casemix adjusted hospital procedural outcomes as (30 day/in hospital) mortality, stroke/death, and major stroke/death, were compared with the national mean. A multivariable logistic regression model (backward elimination at p > 0.10) was used to identify predictors of major stroke/death. Results: A total of 6459 patients, registered by 52 hospitals, were included. The majority (4,832, 75%) were treated <2 weeks after their first hospital consultation, varying from 40% to 93% between hospitals. Mortality, stroke/death, and major stroke/death were, respectively, 1.1%, 3.6%, and 1.8%. Adjusted major stroke/death rates for hospital comparison varied between 0 and 6.5%. Nine hospitals performed significantly better, none performed significantly worse. Predictors of major stroke/death were sex, age, pulmonary disease, presenting neurological symptoms, and peri-operative shunt. Conclusion: CEA in The Netherlands is associated with an overall low mortality and (major) stroke/death rate. Whereas the indicator time to intervention varied between hospitals, mortality and (major) stroke/death were not significantly distinctive enough to identify worse practices and therefore were unsuitable for hospital comparison in the Dutch setting. Additionally, predictors of major stroke/death at population level could be identified.
AB - Background: The Dutch Audit for Carotid Interventions (DACI) registers all patients undergoing interventions for carotid artery stenosis in the Netherlands. This study describes the design of the DACI and results of patients with a symptomatic stenosis undergoing carotid endarterectomy (CEA). It aimed to evaluate variation between hospitals in process of care and (adjusted) outcomes, as well as predictors of major stroke/death after CEA. Methods: All patients with a symptomatic stenosis, who underwent CEA and were registered in the DACI between 2014 and 2016 were included in this cohort. Descriptive analyses of patient characteristics, process of care, and outcomes were performed. Casemix adjusted hospital procedural outcomes as (30 day/in hospital) mortality, stroke/death, and major stroke/death, were compared with the national mean. A multivariable logistic regression model (backward elimination at p > 0.10) was used to identify predictors of major stroke/death. Results: A total of 6459 patients, registered by 52 hospitals, were included. The majority (4,832, 75%) were treated <2 weeks after their first hospital consultation, varying from 40% to 93% between hospitals. Mortality, stroke/death, and major stroke/death were, respectively, 1.1%, 3.6%, and 1.8%. Adjusted major stroke/death rates for hospital comparison varied between 0 and 6.5%. Nine hospitals performed significantly better, none performed significantly worse. Predictors of major stroke/death were sex, age, pulmonary disease, presenting neurological symptoms, and peri-operative shunt. Conclusion: CEA in The Netherlands is associated with an overall low mortality and (major) stroke/death rate. Whereas the indicator time to intervention varied between hospitals, mortality and (major) stroke/death were not significantly distinctive enough to identify worse practices and therefore were unsuitable for hospital comparison in the Dutch setting. Additionally, predictors of major stroke/death at population level could be identified.
KW - Carotid Stenosis/surgery
KW - Endarterectomy, Carotid/mortality
KW - Female
KW - Hospital Mortality
KW - Humans
KW - Male
KW - Netherlands
KW - Patients
KW - Risk Assessment
KW - Risk Factors
KW - Stroke/surgery
KW - Treatment Outcome
KW - Carotid endarterectomy
KW - National clinical audit
KW - Symptomatic carotid artery stenosis
KW - CEA
KW - Quality of care
UR - http://www.scopus.com/inward/record.url?scp=85050799392&partnerID=8YFLogxK
U2 - 10.1016/j.ejvs.2018.05.030
DO - 10.1016/j.ejvs.2018.05.030
M3 - Article
C2 - 30077438
SN - 1078-5884
VL - 56
SP - 476
EP - 485
JO - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
IS - 4
ER -