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 journal › SCORING: Journal article › Research › peer-review
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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 -