Vascular Quality Initiative assessment of compliance with Society for Vascular Surgery clinical practice guidelines on the care of patients with abdominal aortic aneurysm

• Published in: Journal of vascular surgery 2020-09, Vol.72 (3), p.874-885
• Main Authors: Eldrup-Jorgensen, Jens, Kraiss, Larry W., Chaikof, Elliot L., Neal, Dan, Forbes, Thomas L.
• Format: Article
• Language: English
• Subjects: AAA; Antibiotic Prophylaxis - standards; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Clinical registry; Compliance; Guideline Adherence - standards; Guidelines; Hospital Mortality; Humans; North America; Outcome and Process Assessment, Health Care - standards; Outcomes; Postoperative Complications - etiology; Practice Guidelines as Topic - standards; Practice Patterns, Physicians' - standards; Quality Improvement - standards; Quality Indicators, Health Care - standards; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Smoking Cessation; Time Factors; Time-to-Treatment - standards; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality; Vascular Surgical Procedures - standards
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2019.10.097

Professional societies publish clinical practice guidelines to provide evidence-based recommendations to improve care and to reduce practice variation. However, the degree of compliance with the guidelines and its impact on outcomes have not been well defined. This study used the Vascular Quality Initiative (VQI) abdominal aortic aneurysm (AAA) registries to determine current compliance with and impact of recent Society for Vascular Surgery (SVS) AAA guidelines. Recommendations from the SVS AAA guidelines were reviewed and assessed as to whether they could be evaluated with current VQI data sets. The degree of compliance with these individual recommendations was calculated by center and correlated with clinical outcomes. Data were analyzed by univariate analysis and mixed effects multivariable logistic regression. Statistical significance was measured at P < .05. Of the 111 SVS recommendations, 10 could be evaluated using VQI registries. The mean center-specific compliance rate ranged from 40% (smoking cessation 2 weeks before open AAA [OAAA] repair) to 99% (preservation of flow to one internal iliac artery during endovascular aneurysm repair [EVAR]). Some recommendations were associated with improved outcomes (eg, cell salvage for OAAA repair and antibiotic prophylaxis), whereas others were not (eg, EVAR at a center with >10 cases per year or door-to-intervention time