Abdominal aortic aneurysm repair in Veterans Affairs medical centers

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Presentation transcript:

Abdominal aortic aneurysm repair in Veterans Affairs medical centers Andris Kazmers, MD, MSPH, Lloyd Jacobs, MD, Anthony Perkins, MS, S.Martin Lindenauer, MD, Elizabeth Bates, PhD Journal of Vascular Surgery Volume 23, Issue 2, Pages 191-200 (February 1996) DOI: 10.1016/S0741-5214(96)70263-X Copyright © 1996 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Mortality rates after repair of ruptured and nonruptured AAAs remained stable throughout the course of the study. Numbers in parentheses indicate total number of patients who underwent repair at the defined interval. Journal of Vascular Surgery 1996 23, 191-200DOI: (10.1016/S0741-5214(96)70263-X) Copyright © 1996 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Hospital mortality rates as predicted by mortality model based on Poisson regression analysis, defined by the following equation: mortality rate = e-4.31 × e1.62 × rupture rate ×e-0.008 × volume × e0.51 × severity. Mean patient severity and proportion of patients treated for rupture at a given hospital are held constant at various values defined below the graph for the purposes of illustrating the relationship of hospital mortality with surgical volume. It is apparent that hospital mortality rates decrease with increasing surgical valume in all theoretical scenarios illustrated. Journal of Vascular Surgery 1996 23, 191-200DOI: (10.1016/S0741-5214(96)70263-X) Copyright © 1996 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Accuracy of predicted versus observed hospital mortality rates based on Poisson model. Solid line indicates perfect agreement between observed and predicted mortality rates. Spearman rank correlation between the observed and predicted hospital mortality rates was 0.65 (p < 0.0001), which indicated good agreement between observed and predicted mortality rates based on model. Journal of Vascular Surgery 1996 23, 191-200DOI: (10.1016/S0741-5214(96)70263-X) Copyright © 1996 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Actual relationship between PMC-derived severity-of-illness score and patient mortality rates after AAA repair in VA hospitals on basis of outcomes for 3687 patients undergoing AAA repair. As severity of illness increased, so did operative mortality rate after AAA repair. Journal of Vascular Surgery 1996 23, 191-200DOI: (10.1016/S0741-5214(96)70263-X) Copyright © 1996 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Presence and frequency of ICD-9-CM-coded complications in patients undergoing AAA repair are related to prognosis. Patients with increasing numbers of complications have increasing risk of mortality. Journal of Vascular Surgery 1996 23, 191-200DOI: (10.1016/S0741-5214(96)70263-X) Copyright © 1996 Society for Vascular Surgery and the North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions