Morbidity and Mortality in Vascular Surgery: The Kentucky Experience with a Statewide Database

Abstract

Efforts at improvement in quality of care for surgical patients have required multiple strategies that include local, regional, and national efforts to influence processes and outcomes, and examination of outcome databases with and without risk stratification. In the mid to late 1980s, there was an effort to examine the outcome of two high-risk procedures (carotid endarterectomy and abdominal aortic aneurysm repair) on all Medicare patients in the state of Kentucky with an effort to determine the outcome of their treatment and improve the quality of care delivered to them. Even though this experience is somewhat dated, it still represents a unique examination of a large number of patients treated by numerous surgeons. Furthermore, all charts reviewed by the author presented an opportunity to compare actual patient data with that obtained from an administrative data set. This report also examines the author's attempts at improving outcome.

Postintubation Hypotension in General Anesthesia

“…[36][37][38][39][40] Previous studies investigating mortality rates in the vascular surgery population have reported there to be considerable variation between hospitals, due in part to differences in the processes of care. [41][42][43] An important factor in our investigation may be that a significant proportion of ill patients were in the PIH group. Patients with pathologies considered to be more serious (eg, AAA repair and below-knee amputation) experienced PIH at a higher rate than those who did not.…”

“…36 –40 Previous studies investigating mortality rates in the vascular surgery population have reported there to be considerable variation between hospitals, due in part to differences in the processes of care. 41 –43…”