title: Reporting individual surgeon outcomes does not lead to risk aversion in abdominal aortic aneurysm surgery.
abstract: INTRODUCTION Reporting surgeons' outcomes has recently been introduced in the UK. This has the potential to result in surgeons becoming risk averse. The aim of this study was to investigate whether reporting outcomes for abdominal aortic aneurysm (AAA) surgery impacts on the number and risk profile (level of fitness) of patients offered elective treatment. METHODS Publically available National Vascular Registry data were used to compare the number of AAAs treated in those centres across the UK that reported outcomes for the periods 2008-2012, 2009-2013 and 2010-2014. Furthermore, the number and characteristics of patients referred for consideration of elective AAA repair at a single tertiary unit were analysed yearly between 2010 and 2014. Clinic, casualty and theatre event codes were searched to obtain all AAAs treated. The results of cardiopulmonary exercise testing (CPET) were assessed. RESULTS For the 85 centres that reported outcomes in all three five-year periods, the median number of AAAs treated per unit increased between the periods 2008-2012 and 2010-2014 from 192 to 214 per year (p=0.006). In the single centre cohort study, the proportion of patients offered elective AAA repair increased from 74% in 2009-2010 to 81% in 2013-2014, with a maximum of 84% in 2012-2013. The age, aneurysm size and CPET results (anaerobic threshold levels) for those eventually offered elective treatment did not differ significantly between 2010 and 2014. CONCLUSIONS The results do not support the assumption that reporting individual surgeon outcomes is associated with a risk averse strategy regarding patient selection in aneurysm surgery at present.
authors.affiliation: University of Leicester , UK.
authors.forename: A
authors.initials: A
authors.lastname: Saratzis
authors.affiliation: University of Leicester , UK.
authors.forename: A
authors.initials: A
authors.lastname: Thatcher
authors.affiliation: University of Leicester , UK.
authors.forename: M F
authors.initials: MF
authors.lastname: Bath
authors.affiliation: University of Leicester , UK.
authors.forename: D A
authors.initials: DA
authors.lastname: Sidloff
authors.affiliation: University of Leicester , UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Bown
authors.affiliation: University Hospitals Coventry and Warwickshire NHS Trust , UK.
authors.forename: J
authors.initials: J
authors.lastname: Shakespeare
authors.affiliation: University of Leicester , UK.
authors.forename: R D
authors.initials: RD
authors.lastname: Sayers
authors.affiliation: University Hospitals Coventry and Warwickshire NHS Trust , UK.
authors.forename: C
authors.initials: C
authors.lastname: Imray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D066231:Surgeons / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*
keywords: Aneurysm; Outcomes; Surgeon specific mortality data; Vascular