Article type
Year
Abstract
Introduction/Objective: To determine the appropriateness of use of abdominal aortic aneurysm (AAA) surgery in 12 U.S. academic medical centers.
Methods: Random sample of 1092 patients undergoing AAA surgery from 1987 to 1990 with retrospective medical review. Main outcome measures were the percentage of patients who underwent AAA surgery for indications rated by a multi-speciality panel as appropriate, uncertain or inappropriate based on their global assessment of health risks versus benefits.
Results: Approximately 59% of all AAA surgeries were rated appropriate; 38% uncertain; and 3%, inappropriate. The majority of patients (67%) underwent surgery electively for uncomplicated infrarenal AAA (rated appropriate for 46%; uncertain for 50%; and inappropriate for 4%). The percentage of elective infrarenal abdominal aortic aneurysm surgery rated inappropriate (0% to 11%) and uncertain (42% to 57%) varied significantly among institutions. The number of elective infrarenal cases rated uncertain represented 90% of all cases rated uncertain in the study.
Discussion: AAA surgeries were performed infrequently for inappropriate indications at these academic medical centers. However, the large percentage of procedures performed for indications rated uncertain, and the significant variation in appropriateness of elective AAA surgery across institutions, warrants further investigation at both the clinical and policy levels. Randomized trials of elective resection versus initial observation of 4.0-5.4 cm AAA in 15 U.S. Veterans Affairs hospitals and in university and general hospitals across the U.K. are expected to provide, by the end of the 1990s, the first experimental evidence of the efficacy and appropriate use of this procedure. Results were then discussed with vascular surgical leaders. The presentation will discuss their responses to the dissemination of these results.
Methods: Random sample of 1092 patients undergoing AAA surgery from 1987 to 1990 with retrospective medical review. Main outcome measures were the percentage of patients who underwent AAA surgery for indications rated by a multi-speciality panel as appropriate, uncertain or inappropriate based on their global assessment of health risks versus benefits.
Results: Approximately 59% of all AAA surgeries were rated appropriate; 38% uncertain; and 3%, inappropriate. The majority of patients (67%) underwent surgery electively for uncomplicated infrarenal AAA (rated appropriate for 46%; uncertain for 50%; and inappropriate for 4%). The percentage of elective infrarenal abdominal aortic aneurysm surgery rated inappropriate (0% to 11%) and uncertain (42% to 57%) varied significantly among institutions. The number of elective infrarenal cases rated uncertain represented 90% of all cases rated uncertain in the study.
Discussion: AAA surgeries were performed infrequently for inappropriate indications at these academic medical centers. However, the large percentage of procedures performed for indications rated uncertain, and the significant variation in appropriateness of elective AAA surgery across institutions, warrants further investigation at both the clinical and policy levels. Randomized trials of elective resection versus initial observation of 4.0-5.4 cm AAA in 15 U.S. Veterans Affairs hospitals and in university and general hospitals across the U.K. are expected to provide, by the end of the 1990s, the first experimental evidence of the efficacy and appropriate use of this procedure. Results were then discussed with vascular surgical leaders. The presentation will discuss their responses to the dissemination of these results.