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dc.contributor.authorBeck, Adam W
dc.contributor.authorSedrakyan, Art
dc.contributor.authorMao, Jialin
dc.contributor.authorVenermo, Maarit
dc.contributor.authorFaizer, Rumi
dc.contributor.authorDebus, Sebastian
dc.contributor.authorBehrendt, Christian-Alexander
dc.contributor.authorScali, Salvatore
dc.contributor.authorAltreuther, Martin
dc.contributor.authorSchermerhorn, Marc
dc.contributor.authorBeiles, Barry
dc.contributor.authorSzeberin, Zoltan
dc.contributor.authorEldrup, Nikolaj
dc.contributor.authorDanielsson, Gudmundur
dc.contributor.authorThomson, Ian
dc.contributor.authorWigger, Pius
dc.contributor.authorBjörck, Martin
dc.contributor.authorCronenwett, Jack L
dc.contributor.authorMani, Kevin
dc.date.accessioned2017-01-23T14:28:08Z
dc.date.available2017-01-23T14:28:08Z
dc.date.issued2016-12-13
dc.date.submitted2017
dc.identifier.citationVariations in Abdominal Aortic Aneurysm Care: A Report From the International Consortium of Vascular Registries. 2016, 134 (24):1948-1958 Circulationen
dc.identifier.issn1524-4539
dc.identifier.pmid27784712
dc.identifier.doi10.1161/CIRCULATIONAHA.116.024870
dc.identifier.urihttp://hdl.handle.net/2336/620099
dc.description.abstractThis project by the ICVR (International Consortium of Vascular Registries), a collaboration of 11 vascular surgical quality registries, was designed to evaluate international variation in the contemporary management of abdominal aortic aneurysm (AAA) with relation to recommended treatment guidelines from the Society for Vascular Surgery and the European Society for Vascular Surgery.
dc.description.abstractRegistry data for open and endovascular AAA repair (EVAR) during 2010 to 2013 were collected from 11 countries. Variations in patient selection and treatment were compared across countries and across centers within countries.
dc.description.abstractAmong 51 153 patients, 86% were treated for intact AAA (iAAA) and 14% for ruptured AAA. Women constituted 18% of the entire cohort (range, 12% in Switzerland-21% in the United States; P<0.01). Intact AAAs were repaired at diameters smaller than recommended by guidelines in 31% of men (<5.5 cm; range, 6% in Iceland-41% in Germany; P<0.01) and 12% of women with iAAA (<5 cm; range, 0% in Iceland-16% in the United States; P<0.01). Overall, use of EVAR for iAAA varied from 28% in Hungary to 79% in the United States (P<0.01) and for ruptured AAA from 5% in Denmark to 52% in the United States (P<0.01). In addition to the between-country variations, significant variations were present between centers in each country in terms of EVAR use and rate of small AAA repair. Countries that more frequently treated small AAAs tended to use EVAR more frequently (trend: correlation coefficient, 0.51; P=0.14). Octogenarians made up 23% of all patients, ranging from 12% in Hungary to 29% in Australia (P<0.01). In countries with a fee-for-service reimbursement system (Australia, Germany, Switzerland, and the United States), the proportions of small AAA (33%) and octogenarians undergoing iAAA repair (25%) were higher compared with countries with a population-based reimbursement model (small AAA repair, 16%; octogenarians, 18%; P<0.01). In general, center-level variation within countries in the management of AAA was as important as variation between countries.
dc.description.abstractDespite homogeneous guidelines from professional societies, significant variation exists in the management of AAA, most notably for iAAA diameter at repair, use of EVAR, and the treatment of elderly patients. ICVR provides an opportunity to study treatment variation across countries and to encourage optimal practice by sharing these results.
dc.description.sponsorshipUS Food and Drug Administrationen
dc.language.isoenen
dc.publisherLippincott Williams & Wilkinsen
dc.relation.urlhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5147037/en
dc.rightsOpenAccessen
dc.subjectÆðaskurðlækningaren
dc.subjectÆðasjúkdómaren
dc.subjectGæðamaten
dc.subjectTAS12
dc.subject.meshAortic Aneurysm, Abdominalen
dc.subject.meshQuality Improvementen
dc.subject.meshVascular Surgical Proceduresen
dc.titleVariations in Abdominal Aortic Aneurysm Care: A Report From the International Consortium of Vascular Registries.en
dc.typearticleen
dc.contributor.department[ 1 ] Univ Alabama Birmingham, Div Vasc Surg & Endovasc Therapy, Birmingham, AL USA [ 2 ] Weill Cornell Med Coll, Healthcare Policy & Res, New York, NY USA [ 3 ] Helsinki Univ Hosp, Dept Vasc Surg, Helsinki, Finland [ 4 ] Univ Minnesota, Div Vasc Surg, Minneapolis, MN USA [ 5 ] Univ Heart Ctr Hamburg Eppendorf, Dept Vasc Med, Hamburg, Germany [ 6 ] Univ Florida, Div Vasc Surg & Endovasc Therapy, Gainesville, FL USA [ 7 ] St Olavs Hosp, Dept Vasc Surg, Trondheim, Norway [ 8 ] Beth Israel Deaconess Med Ctr, Div Vasc & Endovasc Surg, Boston, MA USA [ 9 ] Australian & New Zealand Soc Vasc Surg, East Melbourne, Australia [ 10 ] Semmelweis Univ, Dept Vasc Surg, Budapest, Hungary [ 11 ] Aarhus Univ Hosp, Dept Cardiothorac & Vasc Surg, Aarhus, Denmark [ 12 ] Natl Univ Hosp Iceland, Dept Surg, Reykjavik, Iceland [ 13 ] Dunedin Publ Hosp, Dunedin Sch Med, Dept Vasc Surg, Dunedin, New Zealand [ 14 ] Kantonsspital Winterthur, Dept Cardiovasc Surg, Winterthur, Switzerland [ 15 ] Uppsala Univ, Dept Surg Sci, Vasc Surg, Uppsala, Sweden [ 16 ] Dartmouth Hitchcock Med Ctr, Vasc Surg Sect, Lebanon, NH 03766 USAen
dc.identifier.journalCirculationen
dc.rights.accessOpen Access - Opinn aðganguren
refterms.dateFOA2018-09-12T16:25:53Z
html.description.abstractThis project by the ICVR (International Consortium of Vascular Registries), a collaboration of 11 vascular surgical quality registries, was designed to evaluate international variation in the contemporary management of abdominal aortic aneurysm (AAA) with relation to recommended treatment guidelines from the Society for Vascular Surgery and the European Society for Vascular Surgery.
html.description.abstractRegistry data for open and endovascular AAA repair (EVAR) during 2010 to 2013 were collected from 11 countries. Variations in patient selection and treatment were compared across countries and across centers within countries.
html.description.abstractAmong 51 153 patients, 86% were treated for intact AAA (iAAA) and 14% for ruptured AAA. Women constituted 18% of the entire cohort (range, 12% in Switzerland-21% in the United States; P<0.01). Intact AAAs were repaired at diameters smaller than recommended by guidelines in 31% of men (<5.5 cm; range, 6% in Iceland-41% in Germany; P<0.01) and 12% of women with iAAA (<5 cm; range, 0% in Iceland-16% in the United States; P<0.01). Overall, use of EVAR for iAAA varied from 28% in Hungary to 79% in the United States (P<0.01) and for ruptured AAA from 5% in Denmark to 52% in the United States (P<0.01). In addition to the between-country variations, significant variations were present between centers in each country in terms of EVAR use and rate of small AAA repair. Countries that more frequently treated small AAAs tended to use EVAR more frequently (trend: correlation coefficient, 0.51; P=0.14). Octogenarians made up 23% of all patients, ranging from 12% in Hungary to 29% in Australia (P<0.01). In countries with a fee-for-service reimbursement system (Australia, Germany, Switzerland, and the United States), the proportions of small AAA (33%) and octogenarians undergoing iAAA repair (25%) were higher compared with countries with a population-based reimbursement model (small AAA repair, 16%; octogenarians, 18%; P<0.01). In general, center-level variation within countries in the management of AAA was as important as variation between countries.
html.description.abstractDespite homogeneous guidelines from professional societies, significant variation exists in the management of AAA, most notably for iAAA diameter at repair, use of EVAR, and the treatment of elderly patients. ICVR provides an opportunity to study treatment variation across countries and to encourage optimal practice by sharing these results.


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