Results from the Australasian Vascular Surgical Audit: the inaugural year

Abstract

The Australian and New Zealand Society for Vascular Surgery has incorporated a constitutional change to administer a self-funded compulsory vascular surgery audit since January 2010. This is a bi-national quality assurance activity that captures all procedures performed in both countries. Data is collected at two points in the clinical admission; at operation and at discharge and data entry is via the Internet. Security is stringent and confidentiality is guaranteed by Commonwealth privilege. Data privacy is maximized by encryption. The application is flexible and administered by a dedicated administrator with a help-desk facility. Reports are available to provide real-time feedback of user performance compared with the peer group data in key categories of arterial surgery. A structured hierarchy for data management has been established to assess four main categories of performance: mortality after aortic surgery, stroke and death after carotid surgery, patency and limb salvage after infrainguinal bypass and patency after arteriovenous access for haemodialysis. Data is analysed using risk-adjustment techniques and an algorithm for management of underperformance has been followed. Data validation has been performed. The outcomes in all categories have been of a high standard and correction of erroneous data in a single statistical outlier has negated underperformance. The audit has captured only 65% of the estimated procedures in Australia in the first year, but data quality is good. The feasibility of a complete compulsory bi-national audit has now been established and will be the benchmark for other craft groups in the current environment of accountability.

The Relationship Between Aortic Aneurysm Surgery Volume and Peri-Operative Mortality in Australia

“…The Australasian Vascular Audit (AVA) database was used to capture all elective and emergency aortic surgical repair procedures between 1 January 2010 and 31 December 2016. 23 The AVA is a nationwide, individual, total practice audit mandated for all members of the Australian and New Zealand Society for Vascular Surgery (ANZSVS) who perform specified (endo) vascular procedures. It captures quality assurance and outcomes data (complications and mortality but not cause of death) for each hospital admission.…”

“…Members of the ANZSVS are required to enter their operative activity for all hospitals in which they conduct audited index vascular procedures (http://www.anzsvs.org.au/ audit/). 23,28 Study patients included all those who underwent standard and complex EVAR for abdominal aortic aneurysm, thoracic endovascular aortic aneurysm repair (TEVAR) for isolated thoracic aortic aneurysm, standard and complex OSR for intact aneurysm disease of the abdominal aorta. Complex EVAR was defined as endovascular repair of any abdominal AE iliac aneurysm disease which included a combination of endovascular branches (BEVAR), fenestrations (FEVAR), or chimney grafts (CHEVAR) for visceral (or iliac) branch arteries.…”

“…Without regulatory body restriction both standard and complex EVAR procedures were broadly integrated into practice within the Australian vascular surgery community. 23 This meant that surgeon and hospital caseload volumes were often lower than those overseas, where more selective introduction of EVAR in to large specialty centres was commonplace. 24e27 It may be that applying results of volume outcome studies from other continents may not be justified.…”

Validation of Australian data in the Australasian Vascular Audit

“…The outcomes are easy to measure and reflect the skill required of a competent surgeon. Risk adjustment and use of funnel plots to detect outliers have been used to conduct clinical assessment of the statistical outliers as described previously . This study has concentrated on the completeness and quality of data used for the audit, which is so important in the exercise of detecting underperformance.…”

“…This study attempts to answer these questions with reference to the Australasian Vascular Audit (AVA). This audit has been in operation since January 2010 and is the official ethics‐approved audit of the Australian and New Zealand Society for Vascular Surgery (ANZSVS) . Four types of vascular operations are audited for in‐hospital outcomes; stroke and death after carotid surgery (open and endovascular), mortality after aortic surgery (open and endovascular), patency and limb loss after infrainguinal bypass and patency after arteriovenous fistula creation for haemodialysis.…”