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

Eleonora G. Karthaus; Anco Vahl; Laurien S. Kuhrij; Bernard H. P. Elsman; Robert H. Geelkerken; Michel W. J. M. Wouters; Jaap F. Hamming; Gert J. de Borst; Joep Teijink; Dutch Society of Vascular Surgery; Steering Committee of the Dutch Audit for Carotid Interventions

doi:10.1016/j.ejvs.2018.05.030

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

Eleonora G. Karthaus, Anco Vahl, Laurien S. Kuhrij, Bernard H. P. Elsman, Robert H. Geelkerken, Michel W. J. M. Wouters, Jaap F. Hamming, Gert J. de Borst^*, Joep Teijink, Dutch Society of Vascular Surgery, Steering Committee of the Dutch Audit for Carotid Interventions

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

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. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

Original language	English
Pages (from-to)	476-485
Number of pages	10
Journal	European Journal of Vascular and Endovascular Surgery
Volume	56
Issue number	4
DOIs	https://doi.org/10.1016/j.ejvs.2018.05.030
Publication status	Published - Oct 2018
Event	Annual Meeting of the European-Society-for-Vascular-Surgery (ESVS) - Lyon, France Duration: 19 Sept 2017 → 22 Sept 2017

Keywords

National clinical audit
Carotid endarterectomy
CEA
Symptomatic carotid artery stenosis
Quality of care
STENOSIS
OUTCOMES
SURGERY
STROKE
TRIALS
REVASCULARIZATION
COMPLICATIONS
PREDICTORS
DEATH

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Cite this

Karthaus, E. G., Vahl, A., Kuhrij, L. S., Elsman, B. H. P., Geelkerken, R. H., Wouters, M. W. J. M., Hamming, J. F., de Borst, G. J., Teijink, J., Dutch Society of Vascular Surgery, & Steering Committee of the Dutch Audit for Carotid Interventions (2018). The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands. European Journal of Vascular and Endovascular Surgery, 56(4), 476-485. https://doi.org/10.1016/j.ejvs.2018.05.030

@article{09c1ae5606894d958457502e2101ff64,

title = "The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands",

abstract = "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. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.",

keywords = "National clinical audit, Carotid endarterectomy, CEA, Symptomatic carotid artery stenosis, Quality of care, STENOSIS, OUTCOMES, SURGERY, STROKE, TRIALS, REVASCULARIZATION, COMPLICATIONS, PREDICTORS, DEATH",

author = "Karthaus, {Eleonora G.} and Anco Vahl and Kuhrij, {Laurien S.} and Elsman, {Bernard H. P.} and Geelkerken, {Robert H.} and Wouters, {Michel W. J. M.} and Hamming, {Jaap F.} and {de Borst}, {Gert J.} and Joep Teijink and {Dutch Society of Vascular Surgery} and {Steering Committee of the Dutch Audit for Carotid Interventions}",

year = "2018",

month = oct,

doi = "10.1016/j.ejvs.2018.05.030",

language = "English",

volume = "56",

pages = "476--485",

journal = "European Journal of Vascular and Endovascular Surgery",

issn = "1078-5884",

publisher = "Elsevier Saunders",

number = "4",

note = "Annual Meeting of the European-Society-for-Vascular-Surgery (ESVS) ; Conference date: 19-09-2017 Through 22-09-2017",

}

Karthaus, EG, Vahl, A, Kuhrij, LS, Elsman, BHP, Geelkerken, RH, Wouters, MWJM, Hamming, JF, de Borst, GJ, Teijink, J, Dutch Society of Vascular Surgery & Steering Committee of the Dutch Audit for Carotid Interventions 2018, 'The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands', European Journal of Vascular and Endovascular Surgery, vol. 56, no. 4, pp. 476-485. https://doi.org/10.1016/j.ejvs.2018.05.030

The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands. / Karthaus, Eleonora G.; Vahl, Anco; Kuhrij, Laurien S. et al.
In: European Journal of Vascular and Endovascular Surgery, Vol. 56, No. 4, 10.2018, p. 476-485.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - The Dutch Audit of Carotid Interventions

T2 - Annual Meeting of the European-Society-for-Vascular-Surgery (ESVS)

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 - Teijink, Joep

AU - Dutch Society of Vascular Surgery

AU - Steering Committee of the Dutch Audit for Carotid Interventions

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. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

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. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

KW - National clinical audit

KW - Carotid endarterectomy

KW - CEA

KW - Symptomatic carotid artery stenosis

KW - Quality of care

KW - STENOSIS

KW - OUTCOMES

KW - SURGERY

KW - STROKE

KW - TRIALS

KW - REVASCULARIZATION

KW - COMPLICATIONS

KW - PREDICTORS

KW - DEATH

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

JF - European Journal of Vascular and Endovascular Surgery

IS - 4

Y2 - 19 September 2017 through 22 September 2017

ER -