Key result
Service reconfiguration and quality improvement initiatives in England reduced elective abdominal aortic aneurysm mortality from 7.9% (1999-2006) to 1.8% by 2012.
Why the study?
Do institutional structures and processes influence postoperative mortality in patients undergoing abdominal aortic aneurysm repair?
Do institutional structures and processes influence postoperative mortality in patients undergoing abdominal aortic aneurysm repair?
Institutional structures and processes significantly influence postoperative mortality outcomes for abdominal aortic aneurysm repair, highlighting the importance of service organization and quality improvement.
May support centralized AAA services; leaves open causality and generalizability without prospective trials.
Annual procedural mortality reports have become mandatory for vascular surgery in England, reflecting a more widespread appetite for transparency and accountability across the National Health Service (NHS) [BMJ 2013;346:f854]. The outcomes of abdominal aortic aneurysm (AAA) repair, in particular, have attracted considerable commentary: from 1999 to 2006, postoperative mortality was higher in England than in many other countries (7.9 vs. 1.9-4.5%) [European Society for Vascular Surgery. 2nd Vascunet Report. 2008]. This stimulated considerable service reconfiguration (centralization), quality improvement initiatives, the uptake of endovascular technology, and the examination of institution-level mortality data [http://www.vascularsociety.org.uk/library/quality-improvement.html], which resulted in a fall in elective AAA mortality to 1.8% by 2012 [http://www.hqip.org.uk/assets/NCAPOP-Library/NCAPOP-2013-2014/Outcomes-after-Elective-Repair-of-Infra-renal-Abdominal-Aortic-Aneurysm.pdf (February 2015)]. Despite improvements at a national level, the outcomes of AAA repair vary considerably between different hospitals in the NHS [Circ Cardiovasc Qual Outcomes 2014;7:131-141], analogous to interprovider variation that has been reported across a range of emergency medical and surgical conditions [BMC Health Serv Res 2014;14:270]. This suggests that underlying institution structures and processes contribute independently to patients' outcomes. There is also considerable evidence that the outcomes of AAA repair vary in different healthcare systems, both in the elective European Society for Vascular Surgery, 2008 and emergency settings. A consideration of the role of structures and processes in influencing outcomes for AAA repair can be conducted across different institutions or even different healthcare systems. This can help identify which factors are consistently associated with the best outcomes, informing efforts to better organize and deliver services for patients requiring vascular surgery.
No takes yet. Share an insight, caveat, or question.
Bahia et al. (2015) conducted a review in Abdominal aortic aneurysm. Service reconfiguration and quality improvement was evaluated on Postoperative mortality. Service reconfiguration and quality improvement initiatives in England reduced elective abdominal aortic aneurysm mortality from 7.9% (1999-2006) to 1.8% by 2012.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: