title: Participation in the Vascular Quality Initiative is associated with improved perioperative medication use, which is associated with longer patient survival.
abstract: OBJECTIVE
  Medical management (MM) with antiplatelet (AP) and statin therapy is recommended for most patients undergoing vascular surgery and has been advocated by the Vascular Quality Initiative (VQI). We analyzed the effect of VQI participation on perioperative (preoperative and postoperative) MM use over time and the effect of discharge MM on patient survival.
  
  
  METHODS
  We studied VQI patients treated with MM preoperatively and at discharge from 2005 to 2014, including all elective carotid endarterectomy/carotid stenting (n = 28,092), suprainguinal/infrainguinal bypass (n = 11,362), peripheral vascular interventions (n = 24,476), open/endovascular abdominal aortic aneurysm repair (n = 13,503), and thoracic endovascular aneurysm repair (n = 702). We examined trends of MM use over time, as well as the effect of duration of VQI participation on MM use. Multivariable logistic regression analysis was performed to identify factors associated with MM use. In addition, the Cox proportional hazards model was used to identify factors associated with 5-year survival.
  
  
  RESULTS
  MM with AP and statin preoperatively and postoperatively across VQI centers improved from 55% in 2005 to 68% in 2009, with a subsequent overall decline to 62% by 2014, coincident with many new centers with lower MM rates joining VQI in 2010. Longer center participation in VQI was associated with improved perioperative MM overall. This was also noted across all procedure types, with MM increasing from 47% to 82% for aneurysm repairs and 69% to 83% for carotid procedures from 1 to 12 years of participation in VQI. After multivariable adjustment, centers in VQI ≥3 years were 30% more likely to have patients on MM (odds ratio, 1.3, 95% confidence interval [CI], 1.3-1.4). Importantly, discharge on AP and statin therapy was associated with improved 5-year survival, compared with discharge on neither medication (82% [95% CI, 81%-83%] vs 67% [95% CI, 62%-72%]), and an adjusted hazard ratio for death of 0.6 (95% CI, 0.5-0.7; P < .001). Discharge on a single medication was associated with intermediate survival at 5 years (AP only: 77% [95% CI, 75%-79%]; statin only: 73% [95% CI, 68%-77%]).
  
  
  CONCLUSIONS
  These data demonstrate that MM is associated with improved survival after a number of vascular procedures. Importantly, VQI participation improves the use of MM, demonstrating that involvement in an organized quality effort can affect patient outcomes.
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: demartino.randall@mayo.edu.
authors.forename: Randall R
authors.initials: RR
authors.lastname: De Martino
authors.affiliation: Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Hoel
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla.
authors.forename: Adam W
authors.initials: AW
authors.lastname: Beck
authors.affiliation: Department of Surgery, Maine Medical Center, Portland, Me.
authors.forename: Jens
authors.initials: J
authors.lastname: Eldrup-Jorgensen
authors.affiliation: Roper St. Francis Heart & Vascular Center, Charleston, SC.
authors.forename: John W
authors.initials: JW
authors.lastname: Hallett
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, Va.
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Upchurch
authors.affiliation: Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Jack L
authors.initials: JL
authors.lastname: Cronenwett
authors.affiliation: Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000592:standards; D019990:Perioperative Care / Q000009:adverse effects / Q000401:mortality / Q000592:standards*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D016016:Proportional Hazards Models; D058996:Quality Improvement / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors