PP45. Assessment of Provided Care in Vascular Surgery: Comparison of Health Care Facilities by Adverse Events Registration Comparison and Adverse Events Registration

To assess the role of adverse events (AE) registries in measuring quality of care in vascular surgery. Crucial aspects of AE registration in order to compare provided care between different institutions were evaluated. Today's medicine urges individual health care facilities and medical professionals to obtain and provide detailed insight in quality of care with the possibility to compare between institutions. AE analysis serves as a mainstay in quality assessment in surgery, but comparison of AE data between institutions can be complex. This is the first prospective study in literature comparing 3 different AE registries in order to evaluate quality of provided care after arterial bypass graft surgery. All admissions involving AEs after infrainguinal bypass graft procedures (BGP) for PAOD from January 2000 till January 2005 in three teaching hospitals in the Netherlands were evaluated: the Red Cross Hospital (RCH) in The Hague and the St. Elisabeth Hospital (EH) in Tilburg and the Leiden University Medical Centre (LUMC). Definition of AE was identical in the institutions. In total 683 BGPs were performed (RCH: n=296, 43%; EH: n=235, 35%, LUMC: n=152, 22%) and 709 AEs were registered. Percentage of AEs varied widely among studied health care facilities (RCH: 17%, EH: 57%, LUMC: 27%, P<0.001) There was a significant difference in indication of operation (critical limb ischaemia; RCH: 59%, EH: 66%, LUMC: 77%, P<0.001), preoperative comorbidity score (ASA 3-4; RCH:26%, EH: 74%, LUMC: 53%, P<0.001), case-mix (cardiac/pulmonary/diabetes; RCH: 37/18/26%, EH: 49/23/36%, LUMC: 63/11/36%, P<0.001/0.02/0.03) and level of distal anastomosis (below knee; RCH: 45%, EH: 62%, LUMC: 52%, P<0.001). The facility with significantly more complex patients and operations had more AEs. AE registration and evaluation provide insight in quality of care in individual institutions over time. However, indication of surgical treatment, comorbidity, case-mix and type of surgery need to be carefully weighted when comparing institutions.