Key result
Reporting individual surgeon outcomes did not lead to risk aversion, as the median number of abdominal aortic aneurysms treated per unit increased from 192 to 214 (p=0.006).
Why the study?
Does reporting individual surgeon outcomes lead to risk aversion in patient selection for elective abdominal aortic aneurysm surgery?
Cohort
Yes
Does reporting individual surgeon outcomes lead to risk aversion in patient selection for elective abdominal aortic aneurysm surgery?
Public reporting of individual surgeon outcomes for AAA surgery does not appear to cause risk aversion or reduce the proportion of patients offered elective repair.
Answers are grounded in this paper and cite their sources.
Public reporting showed no AAA volume drop in this cohort; leaves open effects on risk aversion in other settings.
INTRODUCTION Reporting surgeons' outcomes has recently been introduced in the UK. This has the potential to result in surgeons becoming risk averse. The aim of this study was to investigate whether reporting outcomes for abdominal aortic aneurysm (AAA) surgery impacts on the number and risk profile (level of fitness) of patients offered elective treatment. METHODS Publically available National Vascular Registry data were used to compare the number of AAAs treated in those centres across the UK that reported outcomes for the periods 2008-2012, 2009-2013 and 2010-2014. Furthermore, the number and characteristics of patients referred for consideration of elective AAA repair at a single tertiary unit were analysed yearly between 2010 and 2014. Clinic, casualty and theatre event codes were searched to obtain all AAAs treated. The results of cardiopulmonary exercise testing (CPET) were assessed. RESULTS For the 85 centres that reported outcomes in all three five-year periods, the median number of AAAs treated per unit increased between the periods 2008-2012 and 2010-2014 from 192 to 214 per year (p=0.006). In the single centre cohort study, the proportion of patients offered elective AAA repair increased from 74% in 2009-2010 to 81% in 2013-2014, with a maximum of 84% in 2012-2013. The age, aneurysm size and CPET results (anaerobic threshold levels) for those eventually offered elective treatment did not differ significantly between 2010 and 2014. CONCLUSIONS The results do not support the assumption that reporting individual surgeon outcomes is associated with a risk averse strategy regarding patient selection in aneurysm surgery at present.
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Saratzis et al. (2017) conducted a cohort in Abdominal aortic aneurysm (AAA). Reporting individual surgeon outcomes vs. Prior to reporting outcomes (2008-2012 period) was evaluated on Median number of AAAs treated per unit (p=0.006). Reporting individual surgeon outcomes did not lead to risk aversion, as the median number of abdominal aortic aneurysms treated per unit increased from 192 to 214 (p=0.006).
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