title: Perioperative quality assessment of varicose vein surgery : Commission for quality assessment of the German Society for Vascular Surgery.
abstract: OBJECTIVE
  An estimated 350,000 varicose vein (VV) surgical procedures are performed in Germany each year, with annual treatment costs amounting to about 800 million Euro. To evaluate the outcome quality of this treatment, we examined the intraoperative and postoperative complication rates on record in the VV surgery quality assessment (QA) registry of the German Society for Vascular Surgery (GSVS).
  
  
  METHODS
  Data on 89,647 patients (27,463 men, 62,184 women; average age 52.8 years, range 15-96 years) collected in the GSVS varicose surgery QA registry between 2001 and 2009 were analyzed. In these patients, 95,214 surgical procedures were performed on 105,296 limbs. Complication rates were correlated with the type of VV surgical procedure, with whether surgery was performed on an inpatient or outpatient basis, and with the CEAP classification (C stage) and American Society of Anaesthesiologists' (ASA) stage at the time of surgery. Statistical analyses were performed using a chi-square test, a Cochrane-Armitage test, and an odds ratio calculation.
  
  
  RESULTS
  Intraoperative and postoperative complication was low (0.18 and 0.43 %, respectively), being the lowest for radiofrequency ablation (0.25 %) but not differing significantly from those for endovenous laser therapy and high ligation and stripping. General complications occurred in 0.67 % of outpatients and in 0.25 % of inpatients, a highly significant statistical difference (p < 0.0001, chi-square test). With regard to C stage, the higher the stage, the higher the local complication rate. A clear correlation was also found between preoperative ASA stage and postoperative complication rates: for ASA stages I and II, the complication rates were 0.2 and 0.5 %, respectively, increasing for ASA stage III to 1.2 % and for ASA IV to 2.2 %. The differences between the ASA classes were highly statistically significant (p < 0.0001, Cochrane-Armitage test)
  
  
  CONCLUSIONS
  Outcome quality as reflected in the intraoperative and postoperative complication rates was very good for all patients undergoing inpatient or outpatient VV surgery. Data from the GSVS QA registry shows that VV surgery is performed with very good perioperative results in specialized centers in Germany.
authors.affiliation: Center for Vascular Diseases, Obere Turnstraße 8-10, 90429, Nürnberg, Germany. tn@gefaesszentrum-nuernberg.de.|Department for Vascular Surgery, Martha-Maria Hospital, Nürnberg, Germany. tn@gefaesszentrum-nuernberg.de.
authors.forename: T
authors.initials: T
authors.lastname: Noppeney
authors.affiliation: Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Molkestr.90, 76133, Karlsruhe, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Storck
authors.affiliation: Center for Vascular Surgery and Vascular Medicine, Rheydter Straße 276, 41065, Mönchengladbach, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Nüllen
authors.affiliation: Department for Vascular Surgery, Deaconess Hospital Schwäbisch Hall, Diakoniestraße 10, 75423, Schwäbisch Hall, Germany.
authors.forename: C-G
authors.initials: CG
authors.lastname: Schmedt
authors.affiliation: Department for Vascular Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 907080, Würzburg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Kellersmann
authors.affiliation: Department for Vascular and Endovascular Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Böckler
authors.affiliation: Department for Vascular Surgery, Deaconess Hospital Flensburg, Knuthstraße 1, 24939, Flensburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Walluscheck
authors.affiliation: Center for Vascular and Endovascular Surgery, University Hospital Muenster, Hohenzollerinring 72, 48145, Münster, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Torsello
authors.affiliation: Heart and Vascular Center, University Hospital Hamburg-Eppendorf, Martinistaße 52, 20246, Hamburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Debus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000009:adverse effects; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D053685:Laser Therapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011787:Quality of Health Care; D014648:Varicose Veins / Q000453:epidemiology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D055815:Young Adult
keywords: Complications; Endovenous laser therapy; Quality assessment; Quality indicators; Radiofrequency ablation; Results; Varicose vein surgery