The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands

the Dutch Society of Vascular Surgery; the Steering Committee of the Dutch Audit for Carotid Interventions; the Dutch Institute for Clinical Auditing

doi:10.1016/j.ejvs.2018.05.030

The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands

the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Audit for Carotid Interventions, the Dutch Institute for Clinical Auditing

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: The Dutch Audit for Carotid Interventions (DACI) registers all patients undergoing interventions for carotid artery stenosis in the Netherlands. This study describes the design of the DACI and results of patients with a symptomatic stenosis undergoing carotid endarterectomy (CEA). It aimed to evaluate variation between hospitals in process of care and (adjusted) outcomes, as well as predictors of major stroke/death after CEA. Methods: All patients with a symptomatic stenosis, who underwent CEA and were registered in the DACI between 2014 and 2016 were included in this cohort. Descriptive analyses of patient characteristics, process of care, and outcomes were performed. Casemix adjusted hospital procedural outcomes as (30 day/in hospital) mortality, stroke/death, and major stroke/death, were compared with the national mean. A multivariable logistic regression model (backward elimination at p > 0.10) was used to identify predictors of major stroke/death. Results: A total of 6459 patients, registered by 52 hospitals, were included. The majority (4,832, 75%) were treated <2 weeks after their first hospital consultation, varying from 40% to 93% between hospitals. Mortality, stroke/death, and major stroke/death were, respectively, 1.1%, 3.6%, and 1.8%. Adjusted major stroke/death rates for hospital comparison varied between 0 and 6.5%. Nine hospitals performed significantly better, none performed significantly worse. Predictors of major stroke/death were sex, age, pulmonary disease, presenting neurological symptoms, and peri-operative shunt. Conclusion: CEA in The Netherlands is associated with an overall low mortality and (major) stroke/death rate. Whereas the indicator time to intervention varied between hospitals, mortality and (major) stroke/death were not significantly distinctive enough to identify worse practices and therefore were unsuitable for hospital comparison in the Dutch setting. Additionally, predictors of major stroke/death at population level could be identified.

Original language	English
Pages (from-to)	476-485
Number of pages	10
Journal	European Journal of Vascular and Endovascular Surgery
Volume	56
Issue number	4
DOIs	https://doi.org/10.1016/j.ejvs.2018.05.030
Publication status	Published - Oct 2018

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10.1016/j.ejvs.2018.05.030

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the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Audit for Carotid Interventions, & the Dutch Institute for Clinical Auditing (2018). The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands. European Journal of Vascular and Endovascular Surgery, 56(4), 476-485. https://doi.org/10.1016/j.ejvs.2018.05.030

the Dutch Society of Vascular Surgery ; the Steering Committee of the Dutch Audit for Carotid Interventions ; the Dutch Institute for Clinical Auditing. / The Dutch Audit of Carotid Interventions : Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands. In: European Journal of Vascular and Endovascular Surgery. 2018 ; Vol. 56, No. 4. pp. 476-485.

@article{dafa90dc9c764cbba453a715123b688e,

title = "The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands",

abstract = "Background: The Dutch Audit for Carotid Interventions (DACI) registers all patients undergoing interventions for carotid artery stenosis in the Netherlands. This study describes the design of the DACI and results of patients with a symptomatic stenosis undergoing carotid endarterectomy (CEA). It aimed to evaluate variation between hospitals in process of care and (adjusted) outcomes, as well as predictors of major stroke/death after CEA. Methods: All patients with a symptomatic stenosis, who underwent CEA and were registered in the DACI between 2014 and 2016 were included in this cohort. Descriptive analyses of patient characteristics, process of care, and outcomes were performed. Casemix adjusted hospital procedural outcomes as (30 day/in hospital) mortality, stroke/death, and major stroke/death, were compared with the national mean. A multivariable logistic regression model (backward elimination at p > 0.10) was used to identify predictors of major stroke/death. Results: A total of 6459 patients, registered by 52 hospitals, were included. The majority (4,832, 75%) were treated <2 weeks after their first hospital consultation, varying from 40% to 93% between hospitals. Mortality, stroke/death, and major stroke/death were, respectively, 1.1%, 3.6%, and 1.8%. Adjusted major stroke/death rates for hospital comparison varied between 0 and 6.5%. Nine hospitals performed significantly better, none performed significantly worse. Predictors of major stroke/death were sex, age, pulmonary disease, presenting neurological symptoms, and peri-operative shunt. Conclusion: CEA in The Netherlands is associated with an overall low mortality and (major) stroke/death rate. Whereas the indicator time to intervention varied between hospitals, mortality and (major) stroke/death were not significantly distinctive enough to identify worse practices and therefore were unsuitable for hospital comparison in the Dutch setting. Additionally, predictors of major stroke/death at population level could be identified.",

keywords = "Carotid endarterectomy, CEA, National clinical audit, Quality of care, Symptomatic carotid artery stenosis",

author = "Karthaus, {Eleonora G.} and Anco Vahl and Kuhrij, {Laurien S.} and Elsman, {Bernard H.P.} and Geelkerken, {Robert H.} and Wouters, {Michel W.J.M.} and Hamming, {Jaap F.} and {de Borst}, {Gert J.} and {Van den Akker}, {L. H.} and {Van den Akker}, {P. J.} and Akkersdijk, {G. J.} and Akkersdijk, {G. P.} and Akkersdijk, {W. L.} and {van Andringa de Kempenaer}, {M. G.} and Arts, {C. H.} and Avontuur, {J. A.} and Baal, {J. G.} and Bakker, {O. J.} and R. Balm and Barendregt, {W. B.} and Bender, {M. H.} and Bendermacher, {B. L.} and {van den Berg}, M. and P. Berger and Beuk, {R. J.} and Blankensteijn, {J. D.} and Bleker, {R. J.} and Bockel, {J. H.} and Bodegom, {M. E.} and Bogt, {K. E.} and Boll, {A. P.} and Booster, {M. H.} and {Borger van der Burg}, {B. L.} and {de Borst}, {G. J.} and {Bos- van Rossum}, {W. T.} and J. Bosma and Botman, {J. M.} and Bouwman, {L. H.} and Breek, {J. C.} and V. Brehm and Brinckman, {M. J.} and {van den Broek}, {T. H.} and Brom, {H. L.} and {de Bruijn}, {M. T.} and {de Bruin}, {J. L.} and P. Brummel and {van Brussel}, {J. P.} and Buijk, {S. E.} and Buimer, {M. G.} and Burger, {D. H.} and Buscher, {H. C.} and {den Butter}, G. and E. Cancrinus and Castenmiller, {P. H.} and G. Cazander and Coveliers, {H. M.} and Cuypers, {P. H.} and Daemen, {J. H.} and I. Dawson and Derom, {A. F.} and Dijkema, {A. R.} and J. Diks and Dinkelman, {M. K.} and M. Dirven and Dolmans, {D. E.} and {van Doorn}, {R. C.} and {van Dortmont}, {L. M.} and {van der Eb}, {M. M.} and D. Eefting and {van Eijck}, {G. J.} and Elshof, {Jan Willem} and Elsman, {Bernard H.P.} and {van der Elst}, A. and {van Engeland}, {M. I.} and {van Eps}, {R. G.} and Faber, {M. J.} and {de Fijter}, {W. M.} and B. Fioole and Fritschy, {W. M.} and Geelkerken, {Robert H.} and {van Gent}, {W. B.} and Glade, {G. J.} and B. Govaert and Groenendijk, {R. P.} and {de Groot}, {H. G.} and {van den Haak}, {R. F.} and {de Haan}, {E. F.} and Hajer, {G. F.} and Hamming, {Jaap F.} and {van Hattum}, {E. S.} and Hazenberg, {C. E.} and {Hedeman Joosten}, {P. P.} and Helleman, {J. N.} and {van der Hem}, {L. G.} and Hendriks, {J. M.} and {van Herwaarden}, {J. A.} and Heyligers, {J. M.} and Hinnen, {J. W.} and Hissink, {R. J.} and Ho, {G. H.} and {den Hoed}, {P. T.} and Hoedt, {M. T.} and {van Hoek}, F. and R. Hoencamp and Hoffmann, {W. H.} and Hoksbergen, {A. W.} and Hollander, {E. J.} and Huisman, {L. C.} and Hulsebos, {R. G.} and Huntjens, {K. M.} and Idu, {M. M.} and Jacobs, {M. J.} and {van der Jagt}, {M. F.} and Jansbeken, {J. R.} and Janssen, {R. J.} and Jiang, {H. H.} and {de Jong}, {S. C.} and V. Jongkind and Kapma, {M. R.} and Keller, {B. P.} and {Khodadade Jahrome}, A. and Kievit, {J. K.} and Klemm, {P. L.} and P. Klinkert and B. Knippenberg and Koedam, {N. A.} and Koelemaij, {M. J.} and Kolkert, {J. L.} and Koning, {G. G.} and Koning, {O. H.} and Krasznai, {A. G.} and Krol, {R. M.} and Kropman, {R. H.} and Kruse, {R. R.} and {van der Laan}, L. and {van der Laan}, {M. J.} and {van Laanen}, {J. H.} and Lardenoye, {J. H.} and Lawson, {J. A.} and Legemate, {D. A.} and Leijdekkers, {V. J.} and Lemson, {M. S.} and Lensvelt, {M. M.} and Lijkwan, {M. A.} and Lind, {R. C.} and {van der Linden}, {F. T.} and {Liqui Lung}, {P. F.} and Loos, {M. J.} and Loubert, {M. C.} and Mahmoud, {D. E.} and Manshanden, {C. G.} and Mattens, {E. C.} and R. Meerwaldt and Mees, {B. M.} and R. Metz and Minnee, {R. C.} and {de Mol van Otterloo}, {J. C.} and Moll, {F. L.} and {Montauban van Swijndregt}, {Y. C.} and Morak, {M. J.} and {van de Mortel}, {R. H.} and W. Mulder and Nagesser, {S. K.} and Naves, {C. C.} and Nederhoed, {J. H.} and Nevenzel-Putters, {A. M.} and {de Nie}, {A. J.} and Nieuwenhuis, {D. H.} and J. Nieuwenhuizen and {van Nieuwenhuizen}, {R. C.} and D. Nio and Oomen, {A. P.} and Oranen, {B. I.} and J. Oskam and Palamba, {H. W.} and Peppelenbosch, {A. G.} and {van Petersen}, {A. S.} and Peterson, {T. F.} and Petri, {B. J.} and Pierie, {M. E.} and Ploeg, {A. J.} and Pol, {R. A.} and Ponfoort, {E. D.} and Poyck, {P. P.} and A. Prent and {ten Raa}, S. and Raymakers, {J. T.} and M. Reichart and Reichmann, {B. L.} and Reijnen, {M. M.} and A. Rijbroek and {van Rijn}, {M. J.} and {de Roo}, {R. A.} and Rouwet, {E. V.} and Rupert, {C. G.} and Saleem, {B. R.} and {van Sambeek}, {M. R.} and Samyn, {M. G.} and {van {\textquoteleft}t Sant}, {H. P.} and {van Schaik}, J. and {van Schaik}, {P. M.} and Scharn, {D. M.} and Scheltinga, {M. R.} and A. Schepers and Schlejen, {P. M.} and Schlosser, {F. J.} and Schol, {F. P.} and O. Schouten and Schreinemacher, {M. H.} and Schreve, {M. A.} and Schurink, {G. W.} and Sikkink, {C. J.} and Siroen, {M. P.} and {te Slaa}, A. and Smeets, {H. J.} and L. Smeets and {de Smet}, {A. A.} and {de Smit}, P. and Smit, {P. C.} and Smits, {T. M.} and Snoeijs, {M. G.} and Sondakh, {A. O.} and {van der Steenhoven}, {T. J.} and {van Sterkenburg}, {S. M.} and Stigter, {D. A.} and H. Stigter and Strating, {R. P.} and D. Stulti{\"e}ns and Sybrandy, {J. E.} and Teijink, {J. A.} and Telgenkamp, {B. J.} and Testroote, {M. J.} and The, {R. M.} and Thijsse, {W. J.} and Tielliu, {I. F.} and {van Tongeren}, {R. B.} and Toorop, {R. J.} and Tordoir, {J. H.} and E. Tournoij and M. Truijers and K. T{\"u}rkcan and {Tutein Nolthenius}, {R. P.} and {\"U}nl{\"u} and Vafi, {A. A.} and Vahl, {A. C.} and Veen, {E. J.} and Veger, {H. T.} and Veldman, {M. G.} and Verhagen, {H. J.} and Verhoeven, {B. A.} and Vermeulen, {C. F.} and Vermeulen, {E. G.} and Vierhout, {B. P.} and Visser, {M. J.} and {van der Vliet}, {J. A.} and {Vlijmen - van Keulen}, {C. J.} and Voesten, {H. G.} and R. Voorhoeve and Vos, {A. W.} and {de Vos}, B. and Vos, {G. A.} and Vriens, {B. H.} and Vriens, {P. W.} and {de Vries}, {A. C.} and {de Vries}, {J. P.} and {de Vries}, M. and {van der Waal}, C. and Waasdorp, {E. J.} and {Wallis de Vries}, {B. M.} and {van Walraven}, {L. A.} and {van Wanroij}, {J. L.} and Warl{\'e}, {M. C.} and {van Weel}, V. and {van Well}, {A. M.} and Welten, {G. M.} and Welten, {R. J.} and Wever, {J. J.} and Wiersema, {A. M.} and Wikkeling, {O. R.} and Willaert, {W. I.} and J. Wille and Willems, {M. C.} and Willigendael, {E. M.} and W. Wisselink and Witte, {M. E.} and Wittens, {C. H.} and {Wolf-de Jonge}, {I. C.} and O. Yazar and Zeebregts, {C. J.} and {van Zeeland}, {M. L.} and {de Borst}, {Gert J.} and Elsman, {Bernard H.P.} and Elshof, {Jan Willem} and Geelkerken, {Robert H.} and Hamming, {Jaap F.} and Anco Vahl and Willems, {Martine C.} and {the Dutch Society of Vascular Surgery} and {the Steering Committee of the Dutch Audit for Carotid Interventions} and {the Dutch Institute for Clinical Auditing}",

year = "2018",

month = oct,

doi = "10.1016/j.ejvs.2018.05.030",

language = "English",

volume = "56",

pages = "476--485",

journal = "European Journal of Vascular and Endovascular Surgery",

issn = "1078-5884",

publisher = "W.B. Saunders Ltd",

number = "4",

}

the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Audit for Carotid Interventions & the Dutch Institute for Clinical Auditing 2018, 'The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands', European Journal of Vascular and Endovascular Surgery, vol. 56, no. 4, pp. 476-485. https://doi.org/10.1016/j.ejvs.2018.05.030

The Dutch Audit of Carotid Interventions : Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands. / the Dutch Society of Vascular Surgery; the Steering Committee of the Dutch Audit for Carotid Interventions; the Dutch Institute for Clinical Auditing.

In: European Journal of Vascular and Endovascular Surgery, Vol. 56, No. 4, 10.2018, p. 476-485.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - The Dutch Audit of Carotid Interventions

T2 - Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands

AU - Karthaus, Eleonora G.

AU - Vahl, Anco

AU - Kuhrij, Laurien S.

AU - Elsman, Bernard H.P.

AU - Geelkerken, Robert H.

AU - Wouters, Michel W.J.M.

AU - Hamming, Jaap F.

AU - de Borst, Gert J.

AU - Van den Akker, L. H.

AU - Van den Akker, P. J.

AU - Akkersdijk, G. J.

AU - Akkersdijk, G. P.

AU - Akkersdijk, W. L.

AU - van Andringa de Kempenaer, M. G.

AU - Arts, C. H.

AU - Avontuur, J. A.

AU - Baal, J. G.

AU - Bakker, O. J.

AU - Balm, R.

AU - Barendregt, W. B.

AU - Bender, M. H.

AU - Bendermacher, B. L.

AU - van den Berg, M.

AU - Berger, P.

AU - Beuk, R. J.

AU - Blankensteijn, J. D.

AU - Bleker, R. J.

AU - Bockel, J. H.

AU - Bodegom, M. E.

AU - Bogt, K. E.

AU - Boll, A. P.

AU - Booster, M. H.

AU - Borger van der Burg, B. L.

AU - de Borst, G. J.

AU - Bos- van Rossum, W. T.

AU - Bosma, J.

AU - Botman, J. M.

AU - Bouwman, L. H.

AU - Breek, J. C.

AU - Brehm, V.

AU - Brinckman, M. J.

AU - van den Broek, T. H.

AU - Brom, H. L.

AU - de Bruijn, M. T.

AU - de Bruin, J. L.

AU - Brummel, P.

AU - van Brussel, J. P.

AU - Buijk, S. E.

AU - Buimer, M. G.

AU - Burger, D. H.

AU - Buscher, H. C.

AU - den Butter, G.

AU - Cancrinus, E.

AU - Castenmiller, P. H.

AU - Cazander, G.

AU - Coveliers, H. M.

AU - Cuypers, P. H.

AU - Daemen, J. H.

AU - Dawson, I.

AU - Derom, A. F.

AU - Dijkema, A. R.

AU - Diks, J.

AU - Dinkelman, M. K.

AU - Dirven, M.

AU - Dolmans, D. E.

AU - van Doorn, R. C.

AU - van Dortmont, L. M.

AU - van der Eb, M. M.

AU - Eefting, D.

AU - van Eijck, G. J.

AU - Elshof, Jan Willem

AU - Elsman, Bernard H.P.

AU - van der Elst, A.

AU - van Engeland, M. I.

AU - van Eps, R. G.

AU - Faber, M. J.

AU - de Fijter, W. M.

AU - Fioole, B.

AU - Fritschy, W. M.

AU - Geelkerken, Robert H.

AU - van Gent, W. B.

AU - Glade, G. J.

AU - Govaert, B.

AU - Groenendijk, R. P.

AU - de Groot, H. G.

AU - van den Haak, R. F.

AU - de Haan, E. F.

AU - Hajer, G. F.

AU - Hamming, Jaap F.

AU - van Hattum, E. S.

AU - Hazenberg, C. E.

AU - Hedeman Joosten, P. P.

AU - Helleman, J. N.

AU - van der Hem, L. G.

AU - Hendriks, J. M.

AU - van Herwaarden, J. A.

AU - Heyligers, J. M.

AU - Hinnen, J. W.

AU - Hissink, R. J.

AU - Ho, G. H.

AU - den Hoed, P. T.

AU - Hoedt, M. T.

AU - van Hoek, F.

AU - Hoencamp, R.

AU - Hoffmann, W. H.

AU - Hoksbergen, A. W.

AU - Hollander, E. J.

AU - Huisman, L. C.

AU - Hulsebos, R. G.

AU - Huntjens, K. M.

AU - Idu, M. M.

AU - Jacobs, M. J.

AU - van der Jagt, M. F.

AU - Jansbeken, J. R.

AU - Janssen, R. J.

AU - Jiang, H. H.

AU - de Jong, S. C.

AU - Jongkind, V.

AU - Kapma, M. R.

AU - Keller, B. P.

AU - Khodadade Jahrome, A.

AU - Kievit, J. K.

AU - Klemm, P. L.

AU - Klinkert, P.

AU - Knippenberg, B.

AU - Koedam, N. A.

AU - Koelemaij, M. J.

AU - Kolkert, J. L.

AU - Koning, G. G.

AU - Koning, O. H.

AU - Krasznai, A. G.

AU - Krol, R. M.

AU - Kropman, R. H.

AU - Kruse, R. R.

AU - van der Laan, L.

AU - van der Laan, M. J.

AU - van Laanen, J. H.

AU - Lardenoye, J. H.

AU - Lawson, J. A.

AU - Legemate, D. A.

AU - Leijdekkers, V. J.

AU - Lemson, M. S.

AU - Lensvelt, M. M.

AU - Lijkwan, M. A.

AU - Lind, R. C.

AU - van der Linden, F. T.

AU - Liqui Lung, P. F.

AU - Loos, M. J.

AU - Loubert, M. C.

AU - Mahmoud, D. E.

AU - Manshanden, C. G.

AU - Mattens, E. C.

AU - Meerwaldt, R.

AU - Mees, B. M.

AU - Metz, R.

AU - Minnee, R. C.

AU - de Mol van Otterloo, J. C.

AU - Moll, F. L.

AU - Montauban van Swijndregt, Y. C.

AU - Morak, M. J.

AU - van de Mortel, R. H.

AU - Mulder, W.

AU - Nagesser, S. K.

AU - Naves, C. C.

AU - Nederhoed, J. H.

AU - Nevenzel-Putters, A. M.

AU - de Nie, A. J.

AU - Nieuwenhuis, D. H.

AU - Nieuwenhuizen, J.

AU - van Nieuwenhuizen, R. C.

AU - Nio, D.

AU - Oomen, A. P.

AU - Oranen, B. I.

AU - Oskam, J.

AU - Palamba, H. W.

AU - Peppelenbosch, A. G.

AU - van Petersen, A. S.

AU - Peterson, T. F.

AU - Petri, B. J.

AU - Pierie, M. E.

AU - Ploeg, A. J.

AU - Pol, R. A.

AU - Ponfoort, E. D.

AU - Poyck, P. P.

AU - Prent, A.

AU - ten Raa, S.

AU - Raymakers, J. T.

AU - Reichart, M.

AU - Reichmann, B. L.

AU - Reijnen, M. M.

AU - Rijbroek, A.

AU - van Rijn, M. J.

AU - de Roo, R. A.

AU - Rouwet, E. V.

AU - Rupert, C. G.

AU - Saleem, B. R.

AU - van Sambeek, M. R.

AU - Samyn, M. G.

AU - van ‘t Sant, H. P.

AU - van Schaik, J.

AU - van Schaik, P. M.

AU - Scharn, D. M.

AU - Scheltinga, M. R.

AU - Schepers, A.

AU - Schlejen, P. M.

AU - Schlosser, F. J.

AU - Schol, F. P.

AU - Schouten, O.

AU - Schreinemacher, M. H.

AU - Schreve, M. A.

AU - Schurink, G. W.

AU - Sikkink, C. J.

AU - Siroen, M. P.

AU - te Slaa, A.

AU - Smeets, H. J.

AU - Smeets, L.

AU - de Smet, A. A.

AU - de Smit, P.

AU - Smit, P. C.

AU - Smits, T. M.

AU - Snoeijs, M. G.

AU - Sondakh, A. O.

AU - van der Steenhoven, T. J.

AU - van Sterkenburg, S. M.

AU - Stigter, D. A.

AU - Stigter, H.

AU - Strating, R. P.

AU - Stultiëns, D.

AU - Sybrandy, J. E.

AU - Teijink, J. A.

AU - Telgenkamp, B. J.

AU - Testroote, M. J.

AU - The, R. M.

AU - Thijsse, W. J.

AU - Tielliu, I. F.

AU - van Tongeren, R. B.

AU - Toorop, R. J.

AU - Tordoir, J. H.

AU - Tournoij, E.

AU - Truijers, M.

AU - Türkcan, K.

AU - Tutein Nolthenius, R. P.

AU - Ünlü,

AU - Vafi, A. A.

AU - Vahl, A. C.

AU - Veen, E. J.

AU - Veger, H. T.

AU - Veldman, M. G.

AU - Verhagen, H. J.

AU - Verhoeven, B. A.

AU - Vermeulen, C. F.

AU - Vermeulen, E. G.

AU - Vierhout, B. P.

AU - Visser, M. J.

AU - van der Vliet, J. A.

AU - Vlijmen - van Keulen, C. J.

AU - Voesten, H. G.

AU - Voorhoeve, R.

AU - Vos, A. W.

AU - de Vos, B.

AU - Vos, G. A.

AU - Vriens, B. H.

AU - Vriens, P. W.

AU - de Vries, A. C.

AU - de Vries, J. P.

AU - de Vries, M.

AU - van der Waal, C.

AU - Waasdorp, E. J.

AU - Wallis de Vries, B. M.

AU - van Walraven, L. A.

AU - van Wanroij, J. L.

AU - Warlé, M. C.

AU - van Weel, V.

AU - van Well, A. M.

AU - Welten, G. M.

AU - Welten, R. J.

AU - Wever, J. J.

AU - Wiersema, A. M.

AU - Wikkeling, O. R.

AU - Willaert, W. I.

AU - Wille, J.

AU - Willems, M. C.

AU - Willigendael, E. M.

AU - Wisselink, W.

AU - Witte, M. E.

AU - Wittens, C. H.

AU - Wolf-de Jonge, I. C.

AU - Yazar, O.

AU - Zeebregts, C. J.

AU - van Zeeland, M. L.

AU - de Borst, Gert J.

AU - Elsman, Bernard H.P.

AU - Elshof, Jan Willem

AU - Geelkerken, Robert H.

AU - Hamming, Jaap F.

AU - Vahl, Anco

AU - Willems, Martine C.

AU - the Dutch Society of Vascular Surgery

AU - the Steering Committee of the Dutch Audit for Carotid Interventions

AU - the Dutch Institute for Clinical Auditing

PY - 2018/10

Y1 - 2018/10

N2 - Background: The Dutch Audit for Carotid Interventions (DACI) registers all patients undergoing interventions for carotid artery stenosis in the Netherlands. This study describes the design of the DACI and results of patients with a symptomatic stenosis undergoing carotid endarterectomy (CEA). It aimed to evaluate variation between hospitals in process of care and (adjusted) outcomes, as well as predictors of major stroke/death after CEA. Methods: All patients with a symptomatic stenosis, who underwent CEA and were registered in the DACI between 2014 and 2016 were included in this cohort. Descriptive analyses of patient characteristics, process of care, and outcomes were performed. Casemix adjusted hospital procedural outcomes as (30 day/in hospital) mortality, stroke/death, and major stroke/death, were compared with the national mean. A multivariable logistic regression model (backward elimination at p > 0.10) was used to identify predictors of major stroke/death. Results: A total of 6459 patients, registered by 52 hospitals, were included. The majority (4,832, 75%) were treated <2 weeks after their first hospital consultation, varying from 40% to 93% between hospitals. Mortality, stroke/death, and major stroke/death were, respectively, 1.1%, 3.6%, and 1.8%. Adjusted major stroke/death rates for hospital comparison varied between 0 and 6.5%. Nine hospitals performed significantly better, none performed significantly worse. Predictors of major stroke/death were sex, age, pulmonary disease, presenting neurological symptoms, and peri-operative shunt. Conclusion: CEA in The Netherlands is associated with an overall low mortality and (major) stroke/death rate. Whereas the indicator time to intervention varied between hospitals, mortality and (major) stroke/death were not significantly distinctive enough to identify worse practices and therefore were unsuitable for hospital comparison in the Dutch setting. Additionally, predictors of major stroke/death at population level could be identified.

AB - Background: The Dutch Audit for Carotid Interventions (DACI) registers all patients undergoing interventions for carotid artery stenosis in the Netherlands. This study describes the design of the DACI and results of patients with a symptomatic stenosis undergoing carotid endarterectomy (CEA). It aimed to evaluate variation between hospitals in process of care and (adjusted) outcomes, as well as predictors of major stroke/death after CEA. Methods: All patients with a symptomatic stenosis, who underwent CEA and were registered in the DACI between 2014 and 2016 were included in this cohort. Descriptive analyses of patient characteristics, process of care, and outcomes were performed. Casemix adjusted hospital procedural outcomes as (30 day/in hospital) mortality, stroke/death, and major stroke/death, were compared with the national mean. A multivariable logistic regression model (backward elimination at p > 0.10) was used to identify predictors of major stroke/death. Results: A total of 6459 patients, registered by 52 hospitals, were included. The majority (4,832, 75%) were treated <2 weeks after their first hospital consultation, varying from 40% to 93% between hospitals. Mortality, stroke/death, and major stroke/death were, respectively, 1.1%, 3.6%, and 1.8%. Adjusted major stroke/death rates for hospital comparison varied between 0 and 6.5%. Nine hospitals performed significantly better, none performed significantly worse. Predictors of major stroke/death were sex, age, pulmonary disease, presenting neurological symptoms, and peri-operative shunt. Conclusion: CEA in The Netherlands is associated with an overall low mortality and (major) stroke/death rate. Whereas the indicator time to intervention varied between hospitals, mortality and (major) stroke/death were not significantly distinctive enough to identify worse practices and therefore were unsuitable for hospital comparison in the Dutch setting. Additionally, predictors of major stroke/death at population level could be identified.

KW - Carotid endarterectomy

KW - CEA

KW - National clinical audit

KW - Quality of care

KW - Symptomatic carotid artery stenosis

UR - http://www.scopus.com/inward/record.url?scp=85050799392&partnerID=8YFLogxK

U2 - 10.1016/j.ejvs.2018.05.030

DO - 10.1016/j.ejvs.2018.05.030

M3 - Article

C2 - 30077438

AN - SCOPUS:85050799392

SN - 1078-5884

VL - 56

SP - 476

EP - 485

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

IS - 4

ER -

the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Audit for Carotid Interventions, the Dutch Institute for Clinical Auditing. The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands. European Journal of Vascular and Endovascular Surgery. 2018 Oct;56(4):476-485. doi: 10.1016/j.ejvs.2018.05.030

The Dutch Audit of Carotid Interventions: Transparency in Quality of Carotid Endarterectomy in Symptomatic Patients in the Netherlands

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