Karbase, a Danish register for vascular surgery is presented with data from four years experience. The register consists of 65 variables centered on risk factors, the perioperative course as well as follow-up information. During the four-year period 1989-1992 a total of 4902 admissions were registered in 3810 patients. Surgery was performed during 4005 admissions. Output data from Karbase is presented with results on survival and postoperative complications, related to preoperative risk factors. The incidence of surgical wound infections was 3.9%, with a significant reduction during the years (p = 0.004). Karbase is now used by all vascular surgical units in Denmark. We conclude that the establishment of a continuous registration has been beneficial to the department. We have achieved valid data on treatment, outcome and complications in relation to individual risk factors. In the future the use of Karbase will be extended with the aim of further quality development, locally as well as nation wide.
In order to analyze the possible benefits on the mortality of abdominal aortic aneurysms (AAA) in Viborg county from the establishment of a specialized vascular unit in the county, the periods just before (1986-1988) and just after (1989-1991) the start of the unit were reviewed. Three times as many operations for AAA (104/mill/yr) were carried out after the unit opened. Acute operations increased sevenfold. In 1986-1988 42 persons experienced rupture of AAA. Twenty-six (63%) died outside hospital. Thirteen (32%) died at primary receiving hospitals. Only three patients (7%) were operated. One survived, making the overall mortality 97.5%. The mortality in this period was 187/million persons over 50 years. In 1989-1991 39 persons experienced rupture. Eleven (28%) died outside hospital. Eight (20.5%) died at primary receiving hospitals. One died preoperatively on the vascular unit. Nineteen (49%) reached operation, 13 survived (33%) and six (15.4%) died postoperatively. The overall mortality was 67%, the mortality of AAA was 127/million persons over 50 years. Comparing the two periods, deaths, mortality and overall mortality due to ruptured AAA decreased by 32% after the introduction of the vascular unit.
A 41-year-old woman was treated with a Figulla (Occlutec, Helsingborg, Sweden) atrial septum occluder device with no intraprocedural complications. Five months later, dislocation of the device in the abdominal aorta was detected. The occluder device was located at the level of the celiac axis, nearly obstructing the entire aorta. Owing to total incorporation of the device, endoluminal retrieval was not possible. Through a medial rotation approach, the device was safely removed. This is a rare complication after endoluminal closure of an atrial septum defect. The retrieval possibilities are discussed.
Referral pattern is a potential confounding factor when waiting-list performance is reported across hospitals or periods. A common concern is the ability to accurately estimate proportions of patients undergoing surgery in the recommended time without considering emergency caseload. In this study, the relation between emergency referrals and the rate of elective admissions to hospital within the recommended time was estimated.
A prospective cohort study.
An acute care hospital in Kingston, Ont.
Between 1994 and 1999, 1,173 consecutive patients accepted for elective vascular surgery.
The proportion of patients who underwent surgery within the recommended time, and time to surgery.
The weekly number of emergency cases, enrolment periods, urgency and type of surgery.
Overall, the proportion of patients who underwent surgery within recommended time was 0.45, (95% confidence interval [CI], 0.42-0.48). Adjusted for enrolment period, urgency and type of surgery, the estimated proportion was 0.57, (95% CI, 0.49-0.64). Compared with surgery for peripheral vascular disease, the odds of the procedure being done within the recommended time were 34% lower for aortic abdominal aneurysm repair and 41% lower for carotid endarterectomy. After adjustment for the case-mix and access attributes, the rate of elective admission within recommended time was on average 30% lower for weeks in which there were 1 to 2 emergency cases (rate ratio [RR] = 0.70, [95% CI, 0.53- 0.93]), and 39% lower for weeks with 3 or more emergency cases (RR = 0.61 [95% CI, 0.53-0.83]), relative to weeks with no emergency cases.
When there is an increase in the number of emergency cases, a lower proportion of patients undergo elective surgery within the recommended time. Thus, when performance of surgical servces is evaluated, the probability of patients undergoing elective surgery on time should be adjusted relative to the number of emergency referrals.
Clinical databases are increasingly being employed to evaluate the quality of treatments, including patients with peripheral vascular disease. Valid data is vital to the value of these analyses.
To assess the validity of clinical data in a population-based national vascular registry.
Traditional reproducibility study was supplemented by refilling of data by an independent observer, thereby creating three data sets for comparison.
Twenty prospectively recorded electronic forms from each department were selected randomly from the Danish National Vascular Registry. Data forms were refilled by the surgeons of the department concerned, and by an independent member of the board of the Danish National Vascular Registry. Refilling was performed blinded to the original forms.
A high degree of accuracy of clinical data can be achieved. An independent observer makes it possible to evaluate the classification of observer dependent parameters and explain differences in the reproducibility of data.