John E. Rectenwald, MD, Gilbert R. Upchurch, MD

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Impact of outcomes research on the management of vascular surgery patients John E. Rectenwald, MD, Gilbert R. Upchurch, MD Journal of Vascular Surgery Volume 45, Issue 6, Pages A131-A140 (June 2007) DOI: 10.1016/j.jvs.2007.02.028 Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 1 Outcomes after a relatively uncommon vascular operation: thoracoabdominal aortic aneurysm repair. In-hospital mortality rate after (A) elective and (B) ruptured thoracoabdominal aortic aneurysm repair from 1988 to 1998 in the United States. Comparing 1988-1993 with 1994-1998, mortality improved from (A) 25.7% to (B) 19.3% (P = .002). There was no significant change in mortality over time. (Reprinted with permission from J Vasc Surg 2002;37:1169-74 and J Vasc Surg 2003;38:319-22, 2003.) Journal of Vascular Surgery 2007 45, A131-A140DOI: (10.1016/j.jvs.2007.02.028) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 2 Limited access and poorer outcomes after abdominal aortic aneurysm (AAA) repair in the United States. A, Percent of patients with ruptured AAA repairs with private insurance, Medicaid, and no insurance. B, In-hospital mortality for elective repair of AAA for patients with private insurance, Medicaid, or no insurance (P = .04). (Reprinted with permission from Surgery 2003;134:142-5.) Journal of Vascular Surgery 2007 45, A131-A140DOI: (10.1016/j.jvs.2007.02.028) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 3 Rapid increase of catheter-based therapy to treat renovascular hypertension. There has been a 73% and 56% decline in (P = .033 and P < .001) during the 14-year study period, and angioplasty and stenting has increased 173% (P < .001). (Reprinted with permission from J Vasc Surg 2004;40:717-23.) Journal of Vascular Surgery 2007 45, A131-A140DOI: (10.1016/j.jvs.2007.02.028) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 4 Rates for angioplasty and stenting or aortofemoral bypass surgery from 1996 to 2000 in the United States. The 850% increase in angioplasty and stenting was associated with a 34% increase in the total number of interventions, despite the 15.5% decrease in the number of aortofemoral bypass operations. (Reprinted with permission from Surgery 2004;136:812-8). Journal of Vascular Surgery 2007 45, A131-A140DOI: (10.1016/j.jvs.2007.02.028) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 5 Impact of surgeon volume after carotid endarterectomy (CEA). A, In-hospital mortality, (B) Postoperative stroke rate, and (C) Prolonged length of stay (>4 days) for surgeons with different annual CEA caseload volume. (Reprinted with permission from J Am Coll Surg 2002;195:814-21.) Journal of Vascular Surgery 2007 45, A131-A140DOI: (10.1016/j.jvs.2007.02.028) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 6 In-hospital mortality according to surgeon specialty and high and low individual surgeon volume. Vascular specialization is associated with significantly lower mortality rate compared to general surgeons for both high and low volume surgeons (P < .05). (Reprinted with permission from J Vasc Surg 2003;38:739-44.) Journal of Vascular Surgery 2007 45, A131-A140DOI: (10.1016/j.jvs.2007.02.028) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions