Variations in Abdominal Aortic Aneurysm Care: A Report From the International Consortium of Vascular Registries

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Variations in Abdominal Aortic Aneurysm Care: A Report From the International Consortium of Vascular Registries. / Beck, Adam W; Sedrakyan, Art; Mao, Jialin; Venermo, Maarit; Faizer, Rumi; Debus, Sebastian; Behrendt, Christian-Alexander; Scali, Salvatore; Altreuther, Martin; Schermerhorn, Marc; Beiles, Barry; Szeberin, Zoltan; Eldrup, Nikolaj; Danielsson, Gudmundur; Thomson, Ian; Wigger, Pius; Björck, Martin; Cronenwett, Jack L; Mani, Kevin; International Consortium of Vascular Registries.

In: CIRCULATION, Vol. 134, No. 24, 13.12.2016, p. 1948-1958.

Research output: SCORING: Contribution to journalSCORING: Journal articleResearchpeer-review

Harvard

Beck, AW, Sedrakyan, A, Mao, J, Venermo, M, Faizer, R, Debus, S, Behrendt, C-A, Scali, S, Altreuther, M, Schermerhorn, M, Beiles, B, Szeberin, Z, Eldrup, N, Danielsson, G, Thomson, I, Wigger, P, Björck, M, Cronenwett, JL, Mani, K & International Consortium of Vascular Registries 2016, 'Variations in Abdominal Aortic Aneurysm Care: A Report From the International Consortium of Vascular Registries', CIRCULATION, vol. 134, no. 24, pp. 1948-1958. https://doi.org/10.1161/CIRCULATIONAHA.116.024870

APA

Beck, A. W., Sedrakyan, A., Mao, J., Venermo, M., Faizer, R., Debus, S., Behrendt, C-A., Scali, S., Altreuther, M., Schermerhorn, M., Beiles, B., Szeberin, Z., Eldrup, N., Danielsson, G., Thomson, I., Wigger, P., Björck, M., Cronenwett, J. L., Mani, K., & International Consortium of Vascular Registries (2016). Variations in Abdominal Aortic Aneurysm Care: A Report From the International Consortium of Vascular Registries. CIRCULATION, 134(24), 1948-1958. https://doi.org/10.1161/CIRCULATIONAHA.116.024870

Vancouver

Bibtex

@article{242b4984dc6f48d7920e4362a9d269b0,
title = "Variations in Abdominal Aortic Aneurysm Care: A Report From the International Consortium of Vascular Registries",
abstract = "BACKGROUND: This project by the ICVR (International Consortium of Vascular Registries), a collaboration of 11 vascular surgical quality registries, was designed to evaluate international variation in the contemporary management of abdominal aortic aneurysm (AAA) with relation to recommended treatment guidelines from the Society for Vascular Surgery and the European Society for Vascular Surgery.METHODS: Registry data for open and endovascular AAA repair (EVAR) during 2010 to 2013 were collected from 11 countries. Variations in patient selection and treatment were compared across countries and across centers within countries.RESULTS: Among 51 153 patients, 86% were treated for intact AAA (iAAA) and 14% for ruptured AAA. Women constituted 18% of the entire cohort (range, 12% in Switzerland-21% in the United States; P<0.01). Intact AAAs were repaired at diameters smaller than recommended by guidelines in 31% of men (<5.5 cm; range, 6% in Iceland-41% in Germany; P<0.01) and 12% of women with iAAA (<5 cm; range, 0% in Iceland-16% in the United States; P<0.01). Overall, use of EVAR for iAAA varied from 28% in Hungary to 79% in the United States (P<0.01) and for ruptured AAA from 5% in Denmark to 52% in the United States (P<0.01). In addition to the between-country variations, significant variations were present between centers in each country in terms of EVAR use and rate of small AAA repair. Countries that more frequently treated small AAAs tended to use EVAR more frequently (trend: correlation coefficient, 0.51; P=0.14). Octogenarians made up 23% of all patients, ranging from 12% in Hungary to 29% in Australia (P<0.01). In countries with a fee-for-service reimbursement system (Australia, Germany, Switzerland, and the United States), the proportions of small AAA (33%) and octogenarians undergoing iAAA repair (25%) were higher compared with countries with a population-based reimbursement model (small AAA repair, 16%; octogenarians, 18%; P<0.01). In general, center-level variation within countries in the management of AAA was as important as variation between countries.CONCLUSIONS: Despite homogeneous guidelines from professional societies, significant variation exists in the management of AAA, most notably for iAAA diameter at repair, use of EVAR, and the treatment of elderly patients. ICVR provides an opportunity to study treatment variation across countries and to encourage optimal practice by sharing these results.",
keywords = "Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal/surgery, Delivery of Health Care, Endovascular Procedures, Female, Guidelines as Topic, Humans, Male, Middle Aged, Registries",
author = "Beck, {Adam W} and Art Sedrakyan and Jialin Mao and Maarit Venermo and Rumi Faizer and Sebastian Debus and Christian-Alexander Behrendt and Salvatore Scali and Martin Altreuther and Marc Schermerhorn and Barry Beiles and Zoltan Szeberin and Nikolaj Eldrup and Gudmundur Danielsson and Ian Thomson and Pius Wigger and Martin Bj{\"o}rck and Cronenwett, {Jack L} and Kevin Mani and {International Consortium of Vascular Registries}",
note = "{\textcopyright} 2016 The Authors.",
year = "2016",
month = dec,
day = "13",
doi = "10.1161/CIRCULATIONAHA.116.024870",
language = "English",
volume = "134",
pages = "1948--1958",
journal = "CIRCULATION",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "24",

}

RIS

TY - JOUR

T1 - Variations in Abdominal Aortic Aneurysm Care: A Report From the International Consortium of Vascular Registries

AU - Beck, Adam W

AU - Sedrakyan, Art

AU - Mao, Jialin

AU - Venermo, Maarit

AU - Faizer, Rumi

AU - Debus, Sebastian

AU - Behrendt, Christian-Alexander

AU - Scali, Salvatore

AU - Altreuther, Martin

AU - Schermerhorn, Marc

AU - Beiles, Barry

AU - Szeberin, Zoltan

AU - Eldrup, Nikolaj

AU - Danielsson, Gudmundur

AU - Thomson, Ian

AU - Wigger, Pius

AU - Björck, Martin

AU - Cronenwett, Jack L

AU - Mani, Kevin

AU - International Consortium of Vascular Registries

N1 - © 2016 The Authors.

PY - 2016/12/13

Y1 - 2016/12/13

N2 - BACKGROUND: This project by the ICVR (International Consortium of Vascular Registries), a collaboration of 11 vascular surgical quality registries, was designed to evaluate international variation in the contemporary management of abdominal aortic aneurysm (AAA) with relation to recommended treatment guidelines from the Society for Vascular Surgery and the European Society for Vascular Surgery.METHODS: Registry data for open and endovascular AAA repair (EVAR) during 2010 to 2013 were collected from 11 countries. Variations in patient selection and treatment were compared across countries and across centers within countries.RESULTS: Among 51 153 patients, 86% were treated for intact AAA (iAAA) and 14% for ruptured AAA. Women constituted 18% of the entire cohort (range, 12% in Switzerland-21% in the United States; P<0.01). Intact AAAs were repaired at diameters smaller than recommended by guidelines in 31% of men (<5.5 cm; range, 6% in Iceland-41% in Germany; P<0.01) and 12% of women with iAAA (<5 cm; range, 0% in Iceland-16% in the United States; P<0.01). Overall, use of EVAR for iAAA varied from 28% in Hungary to 79% in the United States (P<0.01) and for ruptured AAA from 5% in Denmark to 52% in the United States (P<0.01). In addition to the between-country variations, significant variations were present between centers in each country in terms of EVAR use and rate of small AAA repair. Countries that more frequently treated small AAAs tended to use EVAR more frequently (trend: correlation coefficient, 0.51; P=0.14). Octogenarians made up 23% of all patients, ranging from 12% in Hungary to 29% in Australia (P<0.01). In countries with a fee-for-service reimbursement system (Australia, Germany, Switzerland, and the United States), the proportions of small AAA (33%) and octogenarians undergoing iAAA repair (25%) were higher compared with countries with a population-based reimbursement model (small AAA repair, 16%; octogenarians, 18%; P<0.01). In general, center-level variation within countries in the management of AAA was as important as variation between countries.CONCLUSIONS: Despite homogeneous guidelines from professional societies, significant variation exists in the management of AAA, most notably for iAAA diameter at repair, use of EVAR, and the treatment of elderly patients. ICVR provides an opportunity to study treatment variation across countries and to encourage optimal practice by sharing these results.

AB - BACKGROUND: This project by the ICVR (International Consortium of Vascular Registries), a collaboration of 11 vascular surgical quality registries, was designed to evaluate international variation in the contemporary management of abdominal aortic aneurysm (AAA) with relation to recommended treatment guidelines from the Society for Vascular Surgery and the European Society for Vascular Surgery.METHODS: Registry data for open and endovascular AAA repair (EVAR) during 2010 to 2013 were collected from 11 countries. Variations in patient selection and treatment were compared across countries and across centers within countries.RESULTS: Among 51 153 patients, 86% were treated for intact AAA (iAAA) and 14% for ruptured AAA. Women constituted 18% of the entire cohort (range, 12% in Switzerland-21% in the United States; P<0.01). Intact AAAs were repaired at diameters smaller than recommended by guidelines in 31% of men (<5.5 cm; range, 6% in Iceland-41% in Germany; P<0.01) and 12% of women with iAAA (<5 cm; range, 0% in Iceland-16% in the United States; P<0.01). Overall, use of EVAR for iAAA varied from 28% in Hungary to 79% in the United States (P<0.01) and for ruptured AAA from 5% in Denmark to 52% in the United States (P<0.01). In addition to the between-country variations, significant variations were present between centers in each country in terms of EVAR use and rate of small AAA repair. Countries that more frequently treated small AAAs tended to use EVAR more frequently (trend: correlation coefficient, 0.51; P=0.14). Octogenarians made up 23% of all patients, ranging from 12% in Hungary to 29% in Australia (P<0.01). In countries with a fee-for-service reimbursement system (Australia, Germany, Switzerland, and the United States), the proportions of small AAA (33%) and octogenarians undergoing iAAA repair (25%) were higher compared with countries with a population-based reimbursement model (small AAA repair, 16%; octogenarians, 18%; P<0.01). In general, center-level variation within countries in the management of AAA was as important as variation between countries.CONCLUSIONS: Despite homogeneous guidelines from professional societies, significant variation exists in the management of AAA, most notably for iAAA diameter at repair, use of EVAR, and the treatment of elderly patients. ICVR provides an opportunity to study treatment variation across countries and to encourage optimal practice by sharing these results.

KW - Aged

KW - Aged, 80 and over

KW - Aortic Aneurysm, Abdominal/surgery

KW - Delivery of Health Care

KW - Endovascular Procedures

KW - Female

KW - Guidelines as Topic

KW - Humans

KW - Male

KW - Middle Aged

KW - Registries

U2 - 10.1161/CIRCULATIONAHA.116.024870

DO - 10.1161/CIRCULATIONAHA.116.024870

M3 - SCORING: Journal article

C2 - 27784712

VL - 134

SP - 1948

EP - 1958

JO - CIRCULATION

JF - CIRCULATION

SN - 0009-7322

IS - 24

ER -