[Annual self-assessment of perioperative complications and early success: the best way to improve the medical results in the Vascular Surgery Department].
In spite of many recent advances, vascular surgery is still weighed down with serious complications which occur in 1 to 5% of open surgery cases and 0 to 2% of endovascular cases. Some of them are due to the specific characteristics of atherosclerotic and aneurysmal diseases; others are associated with the technics of arterial reconstructions; but others are surgeon-dependant as their rate vary from on center to another. Quality of results depend on the experience of one surgeon and his team. This experience is based on an unquantified analysis of past success and failures. However currently, it is necessary to take in account the scientific guidelines as well as the personal results of the surgical team. The latter are known only when they are periodically checked in a systematic process. We report a 23 years experience of annual self assessment of the perioperative complications covering all the arterial reconstructions performed during the previous year. These evaluation had five effects: they linked the physicians and nurses in the quest of optimal efficacy; they focused all the team on the cares and results which needed to be improved; complications and success rates were a guide for the therapeutic choices; reliable results rates allowed a precise information of patients, hospital-managers and lawyers when necessary; they were one of the most important factors of continuing medical education. No other mean can replace these self-assessment procedures: retrospective studies are focused on limited areas; mortality-mobidity conferences are devoted to the recent complications without statistical analysis; the PMSI is directed towards cost-containment rather than quality of results. When a team do not know which results are poor, it is unlikely that they will be improved. We hope that the hospital accreditation which has been introduced in France in 1996, will make mandatory the practice of mortality-morbidity conferences, annual evaluation of perioperative complications and periodic studies of long term results. For medical and economical reasons, the population may require that we systematically monitor our results and take them in account before deciding a treatment. Physicians who are unaware of there own results cannot inspire confidence.
Mellière
Didier
D
Service de Chirurgie Vasculaire-Hôpital Henri Mondor-94010 Créteil.
D005602:France; D006801:Humans; D007431:Intraoperative Complications; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D017064:Process Assessment, Health Care; D014656:Vascular Surgical Procedures / Q000592:standards*