Improving Quality of Carotid Interventions: Identifying Hospital-Level Structural Factors that can Improve Outcomes

Autor: Dylan R. Morris, Richard Bulbulia, Prem Chana, Alison Halliday, Kamran Gaba
Rok vydání: 2021
Předmět:
Carotid Artery Diseases
Cardiovascular event
Stroke rate
medicine.medical_specialty
Time Factors
Critical Care
Heart Diseases
Cost-Benefit Analysis
medicine.medical_treatment
Specialty
Psychological intervention
Carotid endarterectomy
030204 cardiovascular system & hematology
Risk Assessment
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Risk Factors
Humans
Medicine
Hospital Mortality
Hospital Costs
Stroke
Quality Indicators
Health Care
Endarterectomy
Carotid
Sicus
biology
business.industry
Endovascular Procedures
Hospital level
General Medicine
General Review
Length of Stay
biology.organism_classification
medicine.disease
Quality Improvement
Outcome and Process Assessment
Health Care
Treatment Outcome
Hospital Bed Capacity
Emergency medicine
Stents
Surgery
Cardiology and Cardiovascular Medicine
business
Zdroj: Annals of Vascular Surgery
ISSN: 0890-5096
DOI: 10.1016/j.avsg.2020.09.066
Popis: Background “Structural factors” relating to organization of hospitals may affect procedural outcomes. This study's aim was to clarify associations between structural factors and outcomes after carotid endarterectomy (CEA) and carotid endarterectomy stenting (CAS). Methods A systematic review of studies published in English since 2005 was conducted. Structural factors assessed were as follows: population size served by the vascular department; number of hospital beds; availability of dedicated vascular beds; established clinical pathways; surgical intensive care unit (SICU) size; and specialty of surgeon/interventionalist. Primary outcomes were as follows: mortality; stroke; cardiac complications; length of hospital stay (LOS); and cost. Results There were 11 studies (n = 95,100 patients) included in this systematic review. For CEA, reduced mortality (P 75,000 people. Larger hospitals were associated with lower mortality, stroke rate, and cardiac events, compared with smaller hospitals (less than 130 beds). Provision of vascular beds after CEA was associated with lower mortality (P = 0.0008) and fewer cardiac events (P = 0.03). Adherence to established clinical pathways was associated with reduced stroke and cardiac event rates while reducing CEA costs. Large SICUs (≥7 beds) and dedicated intensivists were associated with decreased mortality after CEA while a large SICU was associated with reduced stroke rate (P = 0.001). Vascular surgeons performing CEA were associated with lower stroke rates and shorter LOS (P = 0.0001) than other specialists. CAS outcomes were not influenced by specialty but costless when performed by vascular surgeons (P
Highlights • The organization of hospitals may affect carotid interventional outcomes. • Large vascular units with defined clinical pathways had improved surgical outcomes. • Vascular surgeons had best outcomes after carotid interventions. • These findings may reduce risks and costs associated with carotid interventions.
Databáze: OpenAIRE
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