Reporting individual surgeon outcomes does not lead to risk aversion in abdominal aortic aneurysm surgery.

Saratzis A;Thatcher A; Bath MF; Sidloff DA; Bown MJ; Shakespeare J; Sayers RD;
Imray C,

Annals Of The Royal College Of Surgeons Of England [Ann R Coll
Surg Engl], ISSN: 1478-7083, 2017 Feb; Vol. 99 (2), pp. 161-165;

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
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.