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Pherwani AD, Johal AS, Cromwell DA, Boyle JR, Szeberin Z, Venermo M, Beiles B, Khashram M, Lattmann T, Altreuther ME, Laxdal E, Behrendt CA, Mani K, Budtz-Lilly J. Editor's Choice - Outcomes Following Intact and Ruptured Aneurysm Repair across Nations: Analysis of International Registry Data from the VASCUNET Collaboration 2014 - 2019. Eur J Vasc Endovasc Surg 2024; 68:162-170. [PMID: 38382695 DOI: 10.1016/j.ejvs.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE To determine the peri-operative mortality rate for intact and ruptured abdominal aortic aneurysm (AAA) repair in 10 countries and to compare practice and outcomes over a six year period by age, sex, and geographic location. METHODS This VASCUNET study used prospectively collected data from vascular registries in 10 countries on primary repair of intact and ruptured AAAs undertaken between January 2014 and December 2019. The primary outcome was peri-operative death (30 day or in hospital). Logistic regression models were used to estimate the association between peri-operative death, patient characteristics, and type of procedure. Factors associated with the use of endovascular aortic aneurysm repair (EVAR) were also evaluated. RESULTS The analysis included 50 642 intact and 9 453 ruptured AAA repairs. The proportion of EVARs for intact repairs increased from 63.4% in 2014 to 67.3% in 2016 before falling to 62.3% in 2019 (p < .001), but practice varied between countries. EVAR procedures were more common among older patients (p < .001) and men (p < .001). Overall peri-operative mortality after intact AAA repair was 1.4% (95% confidence interval [CI] 1.3 - 1.5%) and did not change over time. Mortality rates were stable within countries. Among ruptured AAA repairs, the proportion of EVARs increased from 23.7% in 2014 to 35.2% in 2019 (p < .001). The average aortic diameter was 7.8 cm for men and 7.0 cm for women (p < .001). The overall peri-operative mortality rate was 31.3% (95% CI 30.4 - 32.2%); the rates were 36.0% (95% CI 34.9 - 37.2%) for open repair and 19.7% (95% CI 18.2 - 21.3%) for EVAR. This difference and shift to EVAR reduced peri-operative mortality from 32.6% (in 2014) to 28.7% (in 2019). CONCLUSION The international practice of intact AAA repair was associated with low mortality rates in registry reported data. There remains variation in the use of EVAR for intact AAAs across countries. Overall peri-operative mortality remains high after ruptured AAA, but an increased use of EVAR has reduced rates over time.
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Affiliation(s)
- Arun D Pherwani
- Keele University School of Medicine, Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
| | - Amundeep S Johal
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK. http://www.twitter.com/vsqip
| | | | - Jonathan R Boyle
- Cambridge University Hospitals NHS Trust and Department of Surgery, University of Cambridge, Cambridge, UK. http://www.twitter.com/Jonnyboyle1
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. http://www.twitter.com/VenerMa
| | - Barry Beiles
- Australasian Vascular Audit, Australian and New Zealand Society for Vascular Surgery, Melbourne, Australia
| | - Manar Khashram
- University of Auckland, Waikato Hospital, Hamilton, New Zealand. http://www.twitter.com/ManarKhashram
| | - Thomas Lattmann
- Swissvasc Registry, Clinic for Interventional Radiology and Vascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland. http://www.twitter.com/LattmannThomas
| | - Martin E Altreuther
- Section of Vascular Surgery, Department of Surgery, St Olavs Hospital, and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elin Laxdal
- Department of Vascular Surgery, Landspitalinn University Hospital, Reykjavik, Iceland
| | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany. http://www.twitter.com/VASCevidence
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden. http://www.twitter.com/KevinMani7
| | - Jacob Budtz-Lilly
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark
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2
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Ugwummadu C, Schmidt E, Hoeprich M, Bonta A, Ridgway K, Walker L, Witkowski J, Weinstein J, Cooper MR. Improving Compliance with Preoperative Nasal Povidone-Iodine to Prevent Surgical Site Infection in Vascular and Neurosurgery Services in a Community Teaching Hospital. Am J Med Qual 2024; 39:59-68. [PMID: 38403957 DOI: 10.1097/jmq.0000000000000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Surgical site infections (SSI) remain a cause of morbidity, prolonged hospitalization, surgical readmission, and death. Nasal colonization with methicillin-resistant Staphylococcal aureus is a frequent cause of device-related SSI and nasal mupirocin has been used for prevention. More recently, povidone-iodine nasal swabs have become an alternative. It is cheaper, ensures compliance and there are no concerns regarding antimicrobial resistance. However, its adoption was suboptimal in a community hospital system in southwestern Ohio, especially in neurosurgery and vascular surgery. Quality improvement techniques, including solicitation of stakeholder input, surgeons and perioperative nurses' education, and the use of reminders to order and administer the povidone-iodine nasal swabs improved physician ordering and nurse administration compliance, leading to fewer infections. The interventions continued after the project was completed, sustaining decreases in neurosurgery and vascular surgery, and fewer SSI through the first years of the pandemic. Despite the complexity of these surgeries, simple interventions were effective in addressing the problem.
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Affiliation(s)
| | | | | | | | | | | | - Julia Witkowski
- Department of Healthcare Quality and Safety, Jefferson College of Population Health
| | | | - Mary Reich Cooper
- Department of Healthcare Quality and Safety, Jefferson College of Population Health
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3
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Bencheikh N, Zarrintan S, Quatramoni JG, Al-Nouri O, Malas M, Gaffey AC. Vascular Surgery in Low-Income and Middle-Income Countries: A State-of-the-Art Review. Ann Vasc Surg 2023; 95:297-306. [PMID: 37285965 DOI: 10.1016/j.avsg.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) represents 32% of all global deaths. Studies have shown an increase in CVD prevalence and mortality with the most substantial increase in low-income and middle-income countries (LMICs). Within LMICs, we sought to 1) measure the burden of CVD with respect to aortic aneurysm (AA), ischemic stroke (IS), and peripheral arterial disease (PAD); 2) quantify surgical access to vascular surgery services; and 3) identify challenges and solutions to addressing disparities. METHODS The Institute for Health Metrics and Evaluation Global Burden of Disease Results Tool was used to assess the global burden of CVD (AA, PAD, IS). Population data were extracted from the World Bank & Workforce data. A literature review was completed through PubMed. RESULTS The number of deaths attributable to AA, PAD, and IS in LMICs increased by up to 102% between 1990 and 2019. Disability-adjusted life-years (DALYs) lost to AA, PAD, and IS in LMICs also increased by up to 67%. High-income countries (HIC) had a less considerable increase in deaths and DALYs during this time period. There are 101 and 72.7 vascular surgeons per 10 million people in the United States and United Kingdom, respectively. LMICs, such as Morocco, Iran, and South Africa have 10 times less this number. Ethiopia has 0.25 vascular surgeons per 10 million people, 400 times less than the United States. Interventions addressing these global disparities should address infrastructure and financing, data collection and sharing, patient knowledge and beliefs, and workforce development. CONCLUSIONS Extreme regional discrepancies are evidence at a global scale. Identifying mechanisms to expand the vascular surgical workforce to meet the increasing need for vascular surgical access is imminent.
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Affiliation(s)
- Nissma Bencheikh
- Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego, San Diego, CA
| | - Sina Zarrintan
- Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego, San Diego, CA
| | | | - Omar Al-Nouri
- Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego, San Diego, CA
| | - Mahmoud Malas
- Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego, San Diego, CA
| | - Ann C Gaffey
- Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego, San Diego, CA.
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4
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Ghannam MM, Davies JM. Application of Big Data in Vascular Neurosurgery. Neurosurg Clin N Am 2022; 33:469-482. [DOI: 10.1016/j.nec.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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5
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Lareyre F, Behrendt CA, Chaudhuri A, Ayache N, Delingette H, Raffort J. Big Data and Artificial Intelligence in Vascular Surgery: Time for Multidisciplinary Cross-Border Collaboration. Angiology 2022; 73:697-700. [PMID: 35815537 DOI: 10.1177/00033197221113146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Fabien Lareyre
- Department of Vascular Surgery, 70607Hospital of Antibes Juan-les-Pins, Antibes, France.,Université Côte d'Azur, Inserm U1065, C3M, Nice, France
| | - Christian-Alexander Behrendt
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Arindam Chaudhuri
- Bedfordshire - Milton Keynes Vascular Centre, 575329Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Nicholas Ayache
- Université Côte d'Azur84436 Inria, EPIONE Team, Sophia Antipolis, France.,Université Côte d'Azur 3IA Institute, France
| | - Hervé Delingette
- Université Côte d'Azur84436 Inria, EPIONE Team, Sophia Antipolis, France.,Université Côte d'Azur 3IA Institute, France
| | - Juliette Raffort
- Université Côte d'Azur, Inserm U1065, C3M, Nice, France.,Université Côte d'Azur 3IA Institute, France.,Department of clinical Biochemistry, 37045University Hospital of Nice, Nice, France
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6
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Behrendt CA, Adili F, Böckler D, Cotta L, Görtz H, Heckenkamp J, Peter J, Schmandra T, Stojanovic T, Uhl C, Steinbauer M. Das Qualitätssicherungs- und Deviceregister des Deutschen Instituts für Gefäßmedizinische Gesundheitsforschung der DGG im Zeitalter von COVID-19, Big Data und künstlicher Intelligenz. GEFÄSSCHIRURGIE 2022; 27:317-320. [PMID: 36090201 PMCID: PMC9450836 DOI: 10.1007/s00772-022-00916-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/09/2022]
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7
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Vervoort D, Canner JK, Haut ER, Black JH, Abularrage CJ, Zarkowsky DS, Iannuzzi JC, Hicks CW. Racial Disparities Associated With Reinterventions After Elective Endovascular Aortic Aneurysm Repair. J Surg Res 2021; 268:381-388. [PMID: 34399360 PMCID: PMC8678173 DOI: 10.1016/j.jss.2021.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/18/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are substantial racial and socioeconomic disparities underlying endovascular abdominal aortic aneurysm repair (EVAR) in the United States. To date, race-based variations in reinterventions following elective EVAR have not been studied. Here, we aim to examine racial disparities associated with reinterventions following elective EVAR in a real-world cohort. MATERIALS AND METHODS We used the Vascular Quality Initiative EVAR dataset to identify all patients undergoing elective EVAR between January 2009 and December 2018 in the United States. We compared the association of race with reinterventions after EVAR and all-cause mortality using Welch two-sample t-tests, multivariate logistic regression, and Cox proportional hazards analyses adjusting for baseline differences between groups. RESULTS At median follow-up of 1.1 ± 1.1 y (1.3 ± 1.4 y Black, 1.1 ± 1.1 y White; P = 0.02), a total of 1,164 of 42,481 patients (2.7%) underwent reintervention after elective EVAR, including 2.7% (n = 1,096) White versus 3.2% (n = 68) Black (P = 0.21). Black patients requiring reintervention were more frequently female, more frequently current or former smokers, and less frequently insured by Medicare/Medicaid (P < 0.05). After adjusting for baseline differences, the risk of reintervention after elective EVAR was significantly lower for Black versus White patients (HR 0.74, 95% CI 0.55-0.99; P = 0.04). All-cause mortality was comparable between groups (HR 0.81, 95% CI 0.33-2.00, P = 0.65). CONCLUSIONS There are significant differences between Black and White patients in the risk of reintervention after elective EVAR in the United States. The etiology of this difference deserves investigation.
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Affiliation(s)
- Dominique Vervoort
- Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joseph K Canner
- Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elliott R Haut
- Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of Acute Care Surgery, Department of Surgery; Department of Anesthesiology and Critical Care Medicine; Department of Emergency Medicine; The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
| | - James H Black
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher J Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Devin S Zarkowsky
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado School of Medicine, Aurora, Colorado
| | - James C Iannuzzi
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, California
| | - Caitlin W Hicks
- Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Vascular and Endovascular Surgery, University of California, San Francisco, California.
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8
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Kolossváry E, Björck M, Behrendt CA. A Divide between the Western European and the Central and Eastern European Countries in the Peripheral Vascular Field: A Narrative Review of the Literature. J Clin Med 2021; 10:jcm10163553. [PMID: 34441848 PMCID: PMC8397088 DOI: 10.3390/jcm10163553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 12/19/2022] Open
Abstract
Thirty years after the transition period, starting from 1989, Central and Eastern European countries (CEECs), representing one-fifth of the entire European population, share many historical, societal, political, economic, and cultural characteristics. Although accumulating data on coronary heart diseases and cerebrovascular diseases support these observations, in the case of peripheral arterial disease, data are scarce. The present review attempts to summarise the shreds of data that may highlight a divide in this field between CEECs and Western European countries. Disparities in risk factors and peripheral vascular care across Europe seem to be tangible and can be seen as a signal of existing differences. Improvements in research and development and the collection and cross-border share of scientific data are essential to initiate and facilitate convergence in this field.
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Affiliation(s)
- Endre Kolossváry
- Department of Angiology, St. Imre University Teaching Hospital, 1115 Budapest, Hungary
- Correspondence: ; Tel.: +36-30-3069605; Fax: +36-1-2033652
| | - Martin Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, 75121 Uppsala, Sweden;
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
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9
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Current status and future perspectives of collaboration in surgical research: A scoping review of the evidence. Surgery 2021; 170:748-755. [PMID: 34112518 DOI: 10.1016/j.surg.2021.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Surgery is rapidly changing in terms of techniques, education, and methods of conducting research. To keep up with this pace, surgeons have recently focused on collaborative research projects. The aim of this review was to investigate practices for collaborations in surgical research. METHODS A scoping review was conducted according to the guidelines proposed by Peters et al. Publications on patterns of collaboration in surgical research between January 2000 and December 2020, irrespective of the study design or language of publication, which were indexed in PubMed, the Cochrane Library, and Google Scholar, were included. A research librarian assisted in choosing the search terms and conducting the search. The very broad nature of the subject necessitated a pragmatic search strategy, with primary focus on reviews about collaboration. A new form of crowd science was used that explored collaborations using social media and online shared documents. RESULTS The search identified 38 studies that covered different aspects of collaboration in surgical research. Global, specialist, trainee-/student-led, and patient-led collaboratives are growing in number and size. Implementation of information technologies in surgical collaboration is still limited. The review identified attempts to include researchers from low- and middle-income countries in these collaborations, but these were at the early stages. CONCLUSION There are many patterns of collaboration in surgical research. Involvement of low- and middle-income countries will lead to capacity building in these countries, fast recruitment for surgical trials, and more generalizability of trial results. Due to the complex nature of surgical research, implementation of information technologies might improve the quality of research.
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10
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Aziz F, Behrendt CA, Sullivan K, Beck AW, Beiles CB, Boyle JR, Mani K, Benson RA, Wohlauer MV, Khashram M, Jorgensen JE, Lemmon GW. The impact of COVID-19 pandemic on vascular registries and clinical trials. Semin Vasc Surg 2021; 34:28-36. [PMID: 34144744 PMCID: PMC8137351 DOI: 10.1053/j.semvascsurg.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023]
Abstract
Quality improvement programs and clinical trial research experienced disruption due to the coronavirus disease 2019 (COVID-19) pandemic. Vascular registries showed an immediate impact with significant declines in second-quarter vascular procedure volumes witnessed across Europe and the United States. To better understand the magnitude and impact of the pandemic, organizations and study groups sent grass roots surveys to vascular specialists for needs assessment. Several vascular registries responded quickly by insertion of COVID-19 variables into their data collection forms. More than 80% of clinical trials have been reported delayed or not started due to factors that included loss of enrollment from patient concerns or mandated institutional shutdowns, weighing the risk of trial participation on patient safety. Preliminary data of patients undergoing vascular surgery with active COVID-19 infection show inferior outcomes (morbidity) and increased mortality. Disease-specific vascular surgery study collaboratives about COVID-19 were created for the desire to study the disease in a more focused manner than possible through registry outcomes. This review describes the pandemic effect on multiple VASCUNET registries including Germany (GermanVasc), Sweden (SwedVasc), United Kingdom (UK National Vascular Registry), Australia and New Zealand (bi-national Australasian Vascular Audit), as well as the United States (Society for Vascular Surgery Vascular Quality Initiative). We will highlight the continued collaboration of VASCUNET with the Vascular Quality Initiative in the International Consortium of Vascular Registries as part of the Medical Device Epidemiology Network coordinated registry network. Vascular registries must remain flexible and responsive to new and future real-world problems affecting vascular patients.
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Affiliation(s)
- Faisal Aziz
- Integrated Vascular Surgery Program, Penn State Health Heart and Vascular Institute, Hershey, PA
| | | | | | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - C Barry Beiles
- Australian and New Zealand Society for Vascular Surgery, Australasian Vascular Audit, Melbourne, Victoria, Australia
| | - Jon R Boyle
- University of Cambridge, Cambridge, Cambridgeshire, UK; Vascular Society of Great Britain and Ireland, Staffordshire, UK
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ruth A Benson
- University Hospital Coventry and Warwickshire, West Midlands, UK
| | - Max V Wohlauer
- Vascular Surgery, University of Colorado, Denver, CO; Vascular Surgery COVID-19 Collaborative
| | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, NZ
| | - Jens Eldrup Jorgensen
- Tufts University School of Medicine, Boston, MA; Patient Safety Organization, Society for Vascular Surgery, Rosemont, IL
| | - Gary W Lemmon
- Patient Safety Organization, Society for Vascular Surgery, Rosemont, IL; Indiana University, 1801 N Senate Boulevard, D-3500, Indianapolis, IN 46202.
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11
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Spanos K, Behrendt CA, Kouvelos G, Giannoukas AD, Kölbel T. A new randomized controlled trial on abdominal aortic aneurysm repair is needed. J Vasc Surg 2020; 72:2145-2148. [DOI: 10.1016/j.jvs.2020.06.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 06/05/2020] [Indexed: 12/22/2022]
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12
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Fraser AG. Postmarket surveillance of high-risk medical devices needs transparent, comprehensive and independent registries. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2020; 2:e000065. [PMID: 35051246 PMCID: PMC8647614 DOI: 10.1136/bmjsit-2020-000065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- Alan G Fraser
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
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13
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Behrendt CA, Sigvant B, Kuchenbecker J, Grima MJ, Schermerhorn M, Thomson IA, Altreuther M, Setacci C, Svetlikov A, Laxdal EH, Goncalves FB, Secemsky EA, Debus ES, Cassar K, Beiles B, Beck AW, Mani K, Bertges D. Editor's Choice - International Variations and Sex Disparities in the Treatment of Peripheral Arterial Occlusive Disease: A Report from VASCUNET and the International Consortium of Vascular Registries. Eur J Vasc Endovasc Surg 2020; 60:873-880. [PMID: 33004283 PMCID: PMC8080993 DOI: 10.1016/j.ejvs.2020.08.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/30/2020] [Accepted: 08/17/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study was to determine sex specific differences in the invasive treatment of symptomatic peripheral arterial occlusive disease (PAOD) between member states participating in the VASCUNET and International Consortium of Vascular Registries. METHODS Data on open surgical revascularisation and peripheral vascular intervention (PVI) of symptomatic PAOD from 2010 to 2017 were collected from population based administrative and registry data from 11 countries. Differences in age, sex, indication, and invasive treatment modality were analysed. RESULTS Data from 11 countries covering 671 million inhabitants and 1 164 497 hospitalisations (40% women, mean age 72 years, 49% with intermittent claudication, 54% treated with PVI) in Europe (including Russia), North America, Australia, and New Zealand were included. Patient selection and treatment modality varied widely for the proportion of female patients (23% in Portugal and 46% in Sweden), the proportion of patients with claudication (6% in Italy and 69% in Russia), patients' mean age (70 years in the USA and 76 years in Italy), the proportion of octogenarians (8% in Russia and 33% in Sweden), and the proportion of PVI (24% in Russia and 88% in Italy). Numerous differences between females and males were observed in regard to patient age (72 vs. 70 years), the proportion of octogenarians (28% vs. 15%), proportion of patients with claudication (45% vs. 51%), proportion of PVI (57% vs. 51%), and length of hospital stay (7 days vs. 6 days). CONCLUSION Remarkable differences regarding the proportion of peripheral vascular interventions, patients with claudication, and octogenarians were seen across countries and sexes. Future studies should address the underlying reasons for this, including the impact of national societal guidelines, reimbursement, and differences in health maintenance.
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Affiliation(s)
- Christian-Alexander Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Birgitta Sigvant
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jenny Kuchenbecker
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Matthew J Grima
- Department of Surgery, Vascular Unit, Mater Dei Hospital, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Marc Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - Ian A Thomson
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Martin Altreuther
- Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Carlo Setacci
- Università degli Studi di Siena, Vascular and Endovascular Surgery, Siena, Italy
| | - Alexei Svetlikov
- Department of Cardiovascular Surgery, The I.I. Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - Elin H Laxdal
- Department of Vascular Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Eric A Secemsky
- Division of Cardiology, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - E Sebastian Debus
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kevin Cassar
- Department of Surgery, Vascular Unit, Mater Dei Hospital, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Barry Beiles
- Australian and New Zealand Society for Vascular Surgery, Melbourne, Australia
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, AB, USA
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Daniel Bertges
- Division of Vascular Surgery, University of Vermont Medical Centre, Burlington, VT, USA
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14
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Wanhainen A, Mani K. The way forward to understand aortic disease. J Intern Med 2020; 288:3-5. [PMID: 32133695 DOI: 10.1111/joim.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- A Wanhainen
- From the, Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - K Mani
- From the, Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
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