Abdominal Aortic Aneurysm Repair Surgery - Video Replay

Abdominal Aortic Aneurysm (AAA) Repair Quality Measures

Quality measures, also referred to as quality indicators, can be used to report how well an organization provides care for patients undergoing certain procedures and/or for patients with particular medical conditions. They assess aspects of healthcare structure (such as types and availability of services), outcomes (such as infection rates, mortality, length of stay), or processes (such as giving antibiotics prior to and after certain surgical procedures).

Research was conducted to determine the established or emerging quality measures for abdominal aortic aneurysm (AAA) repair. These quality statements, which appear below, provide relevant information needed to help you make more informed decisions about your healthcare.

Annual surgical volume for abdominal aortic aneurysm (AAA) repair procedures

The Leapfrog Group, a national organization devoted to improving patient safety, has suggested that a surgical program that performs at least 30 abdominal aortic aneurysm (AAA) repairs per year has better outcomes. (Surgery, September 2001: 130(3); 415-422) In 2003, the Leapfrog Group revised the procedure threshold levels proposed earlier to recommend that 50 AAA procedures per year should be the minimum volume standard. (Annals of Surgery, October 2003: 238(4); 447-457)

  • Robert Wood Johnson University Hospital’s surgeons performed 107 AAA repair procedures in 2004. Projections indicate that 109 procedures will be performed in 2005. Robert Wood Johnson University Hospital has exceeded the threshold number of surgeries since the inception of the Leapfrog program.

Physician board certification

Abdominal aortic aneurysm (AAA) repair may be performed by a variety of different types of surgeons.

A board-certified physician has completed an approved educational training program and an evaluation process including an examination designed to assess the knowledge, skills and experience necessary to provide quality patient care in that specialty. A specialty certificate is issued by a medical specialty certifying board, which is valid nationwide. Although certification is not required for an individual physician to practice medicine, most hospitals and managed care organizations require that at least a certain percentage of their staff be "board certified." (American Board of Medical Specialties)

  • All of Robert Wood Johnson University Hospital's surgeons who perform AAA are board certified.

Vascular surgeon availability for abdominal aortic aneurysm (AAA) repair

The Dartmouth Atlas of Vascular Health Care found that, in a nationwide sample of Medicare patients undergoing vascular surgery, vascular surgeons performed 39 percent of all elective (non-emergency) abdominal aortic aneurysm (AAA) repairs, versus 33 percent for cardiothoracic surgeons and 28 percent for general surgeons. Vascular surgeons as a group had a lower 30-day mortality rate than the cardiothoracic and general surgeons. In addition, as a group, vascular surgeons performed more elective AAA repairs per individual surgeon than did the other two groups. (Journal of Vascular Surgery, October 2001: 34(4); 751-756) Other studies, using patient data from Ontario, Canada and Florida, have found similar results. (Journal of Vascular Surgery, March 2001: 33(3); 447-452)

Availability of endovascular aneurysm repair (EVAR)

Since its introduction in 1991, endovascular aneurysm repair (a procedure in which a stent, or tubelike structure, is inserted into the aorta, the artery that carries blood from the heart to the rest of the body, through an incision in the groin) of abdominal aortic aneurysms (AAA) has become widely used to repair AAA.

Because the procedure is much less invasive (the incision is much smaller and less penetrating) than traditional open repair, endovascular aneurysm repair (EVAR) has been shown to have more short-term benefits, such as decreased length of hospitalization, reduced intensive care unit (ICU) stays, less blood loss, fewer major complications, and faster recovery. However, the long-term durability and effectiveness of EVAR has not been definitively proved by clinical studies.

EVAR may be preferred in high-risk patients, such as those who are older and/or with increased risk factors such as heart disease, kidney disease, lung disease, or other conditions or circumstances. (Journal of Vascular Surgery, May 2003: 37(5); 1106-1117)

  • Endovascular aneurysm repair is available at Robert Wood Johnson University Hospital. 74 percent of AAA repair surgery performed between January and August, 2005 were done using the endovascular approach.

Inpatient mortality rate for AAA repair

According to the most recent national data available from the Healthcare Cost and Utilization Project’s (HCUP) Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality (AHRQ), the inpatient mortality rate for abdominal aortic aneurysm (AAA) was 7.9 percent. (HCUP).

  • The inpatient mortality rate for AAA repair at Robert Wood Johnson University Hospital was 4.8 percent in 2004, which is better than the rate for AAA repair in HCUP’s Nationwide Inpatient Sample. This includes all AAA repair patients meeting the AHRQ definition.

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