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• W2912572715 abstract "This represents yet another carefully written report from the data collected by the Vascular Study Group of Northern New England (VSGNNE). They have begun the arduous and necessary task of correlating preoperative risk factor assessment with postoperative outcome data, to help guide vascular surgeons in their choice of therapy for patients with vascular disease. To date, they have reported outcomes of carotid therapies and several aspects of lower extremity revascularization. Rather than using traditional 30-day mortality, the authors acknowledge that recovery from intervention often spans several weeks to months, and from a patient perspective one-year outcomes have more relevance. This report serves two primary goals – establishing preoperative predictors of success, and developing benchmarks for hospitals, and eventually individual surgeons, to identify practices and procedures that could be adopted or modified for improvements in care. The first goal leads them to their most controversial suggestion: “Therefore, successful surgeons must select for operation only those patients who will live for at least a year after surgery, and only those patients who will not suffer amputation or graft occlusion within the first year after their bypass.” As we encounter increasingly aged and ill patients, quality of life as well as longevity becomes a critical factor. Many patients, if afforded the option, would prefer limb salvage to amputation if the recovery and rehab times were similar. Perhaps if the authors were able to incorporate their previously published risk factors for predicting independent ambulation (age, preoperative ambulatory ability, independent living status, critical limb ischemia) into their model, a combined quality/quantity of life estimate could be reached. They acknowledge the difficulty of this, but it is certainly a worthy long term goal. The second goal of this study and of the VSGNNE is timely and prescient. As Congress and the Administration wrestle with healthcare expenditures, and propose a new Comparative Effectiveness Research Institute, it is critical that vascular surgeons take the lead in establishing outcomes models, or else they will be provided by other specialty or governmental groups. Which specialty is better equipped to develop outcomes models honestly and without bias, as we provide comprehensive medical, interventional and surgical care to our patients? As with the National Surgical Quality Improvement Project, identification of institutions with both poor and superior performance compared to established benchmarks is only the first step – the true utility of these studies for individual surgeons and institutions is to identify practices and procedures that could be adopted or modified for improvements in care. As with many such studies, despite a carefully constructed reporting system and the participation of multiple institutions, some questions remain unanswered due to relatively small numbers and infrequent outcomes. Thus one intriguing question remains – what factors lead to better than expected outcomes at one center, and worse outcomes at another? Factors associated with death 1 year after lower extremity bypass in Northern New EnglandJournal of Vascular SurgeryVol. 51Issue 1PreviewUsing 30-day operative mortality reported with lower extremity bypass (LEB) in preoperative decision making may underestimate the actual death rate encountered before patients have truly recovered from surgery, especially in elderly, debilitated patients with significant tissue loss. Therefore, we examined preoperative, patient-level risk factors that predict survival within the first year following LEB. Full-Text PDF Open Archive" @default.
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• W2912572715 date "2010-01-01" @default.
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• W2912572715 title "Invited commentary" @default.
• W2912572715 doi "https://doi.org/10.1016/j.jvs.2009.08.018" @default.
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