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

Eleonora G Karthaus; Anco Vahl; Laurien S Kuhrij; Bernard H P Elsman; Robert H Geelkerken; Michel W J M Wouters; Jaap F Hamming; Gert J de Borst; Dutch Society of Vascular Surgery; Steering Committee of the Dutch Audit for Carotid Interventions; 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

Eur J Vasc Endovasc Surg. 2018 Oct;56(4):476-485. doi: 10.1016/j.ejvs.2018.05.030. Epub 2018 Aug 1.

Authors

Eleonora G Karthaus¹, Anco Vahl², Laurien S Kuhrij³, Bernard H P Elsman⁴, Robert H Geelkerken⁵, Michel W J M Wouters⁶, Jaap F Hamming⁷, Gert J de Borst⁸; Dutch Society of Vascular Surgery; Steering Committee of the Dutch Audit for Carotid Interventions; Dutch Institute for Clinical Auditing

Collaborators

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

Affiliations

¹ Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands; Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
² Department of Surgery, OLVG, Amsterdam, The Netherlands; Department of Clinical Epidemiology, OLVG, Amsterdam, The Netherlands.
³ Dutch Institute for Clinical Auditing, Leiden, The Netherlands; Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands.
⁴ Department of Surgery, Deventer Hospital, Deventer, The Netherlands.
⁵ Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands; Faculty of Technical Sciences, University of Twente, Enschede, The Netherlands.
⁶ Dutch Institute for Clinical Auditing, Leiden, The Netherlands; Department of Surgery, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
⁷ Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
⁸ Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands. Electronic address: g.j.deborst-2@umcutrecht.nl.

PMID: 30077438
DOI: 10.1016/j.ejvs.2018.05.030

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: CEA; Carotid endarterectomy; National clinical audit; Quality of care; Symptomatic carotid artery stenosis.

MeSH terms

Carotid Stenosis / surgery
Endarterectomy, Carotid / mortality*
Female
Hospital Mortality*
Humans
Male
Netherlands
Patients*
Risk Assessment
Risk Factors
Stroke / surgery*
Treatment Outcome