Vascular audit shows more patients surviving major artery surgery

Mortality rates for thousands of patients undergoing a major form of artery surgery have fallen by a quarter in just 18 months ( from 2.4% to 1.8%) and 98% of patients now survive this major operation.

These are the findings of the second Abdominal Aortic Aneurysm (AAA) Mortality Report, commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) and carried out by the Royal College of Surgeons and the Vascular Society. It details patient mortality rates for more than 13,000 operations in NHS hospitals in the UK, including Scotland, Wales and Northern Ireland between January 2010 and December 2012.

The Vascular Society believes that this improvement has been driven by a national AAA Quality Improvement Programme funded by the Health Foundation, which was completed in 2012. This demonstrated a number of aspects of the patient pathway that could be improved to drive better outcomes from surgery. The Society has also supported the national AAA screening programme aimed at early detection and prevention of AAA rupture.

AAA is a life-threatening but often symptom-free condition where a bulge forms in the main blood vessel leading from the heart to the lower half of the body. The disease most commonly occurring in those aged 65 and over is more likely among men and smokers. If this bulge ruptures it causes catastrophic internal bleeding that can kill in minutes.The risks of elective surgery are balanced against the extremely high mortality risk of leaving untreated – 80 per cent of people with a ruptured AAA will die before getting to hospital and approximately 50 per cent of those who make it there will die in the operating theatre.

On basis of the two major Randomised Clinical Trials (EVAR 1 and DREAM), increasing numbers of patients are now undergoing minimally invasive endovascular repair (EVAR) surgery in the UK, as compared with more complex open surgery.The organisation says that this has played a significant role in the reduction in death rates.

The National Vascular Database shows that the postoperative mortality was 3.8% for the 4,700 patients having open surgery and 0.8% for the 8,700 patients having the endovascular repair, demonstrating that patients who are suitable for EVAR have far better outcomes. It should, however, be noted that not all patients are suitable for EVAR and some still require open surgery.

Over the three year period the proportion of elective AAA repairs performed as EVAR procedures increased from 62% in 2010 to 67% in 2012.

The aim of the audit is to measure the quality and results of care for patients who undergo vascular surgery.

Professor Julian Scott, President of the Vascular Society, said:

‘This follow-up report shows a wide uptake in endovascular repair for elective AAA and a significant reduction in mortality for AAA over a relatively short period of time. It reinforces our commitment to continuous quality improvement and patient safety.’

The new National Vascular Registry will improve the quality of data collected and enable clinicians to continue their ongoing quality improvement and provide outcome information one year after the surgical procedure. We believe that this is an important development for patients, relatives and clinicians. The report compares data gathered via the audit with data gathered from NHS statistics to show which Trusts are accurately recording their results. Trusts are then traffic light graded on the basis of both mortality rate and data quality. This will continue to drive individual Trusts to improve the coding of procedures and quality of data capture within the National Vascular Registry.’

Notes to Editor:

1. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808.
2. Hospital Episode Statistics contains details of all admissions to NHS hospitals and all NHS outpatient appointments in England. It is a main data source for a wide range of healthcare analyses for the NHS, government, and many other organisations and individuals.
3. The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aims are to promote quality improvement and, in particular, increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Their purpose is to engage clinicians across England and Wales in systematic evaluation of their clinical practice against standards, and support and encourage improvement in the quality of treatment and care. The programme comprises more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions.
4. Patient information leaflets on AAA, open repair and EVAR can be found on the Circulation Foundation’s Website
5. The first ever  UK wide audit of elective AAA repair, published last year, showed that hospitals with higher volumes of patients have better outcomes with death rates half that of the lowest volume hospitals. This suggests that elective AAA surgery should be provided in fewer specialist units.

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