1
|
Habbous S, Ford M, Bar-Ziv S, Donovan T, Hellsten E. The impact of the COVID-19 pandemic on longitudinal trends of surgical mortality and inpatient quality of care in Ontario, Canada. J Adv Nurs 2024. [PMID: 38491720 DOI: 10.1111/jan.16136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/27/2023] [Accepted: 02/18/2024] [Indexed: 03/18/2024]
Abstract
AIMS Previous studies have shown the COVID-19 pandemic was associated with reductions in volume across a spectrum of non-SARS-CoV-2 hospitalizations. In the present study, we examine the impact of the pandemic on patient safety and quality of care. DESIGN This is a retrospective population-based study of discharge abstracts. METHODS We applied a set of nationally validated indicators for measuring the quality of inpatient care to hospitalizations in Ontario, Canada between January 2010 and December 2022. We measured 90-day mortality after selected types of higher risk admissions (such as cancer surgery and cardiovascular emergency) and the rate of patient harm events (such as delirium, pressure injuries and hospital-acquired infections) occurring during the hospital stay. RESULTS A total 13,876,377 hospitalization episodes were captured. Compared with the pre-pandemic period, and independent of SARS-CoV-2 infection, the pandemic period was associated with higher rates of mortality after bladder cancer resection (adjusted risk ratio [aRR] 1.20 (1.07-1.34)) and open repair for abdominal aortic aneurysm (aRR 1.45 (1.06-1.99)). The pandemic was also associated with higher rates of delirium (adjusted odds ratio [aOR] 1.04 (1.02-1.06)), venous thromboembolism (aOR 1.10 (1.06-1.13)), pressure injuries (aOR 1.28 (1.24-1.33)), aspiration pneumonitis (aOR 1.15 (1.12-1.18)), urinary tract infections (aOR 1.02 (1.01-1.04)), Clostridiodes difficile infection (aOR 1.05 (1.02-1.09)), pneumothorax (aOR 1.08 (1.03-1.13)), and use of restraints (aOR 1.12 (1.10-1.14)), but was associated with lower rates of viral gastroenteritis (aOR 0.22 (0.18-0.28)). During the pandemic, SARS-CoV-2-positive admissions were associated with a higher likelihood of various harm events. CONCLUSION The COVID-19 pandemic was associated with higher rates of patient harm for a wide range of non-SARS-CoV-2 inpatient populations. IMPACT Understanding which quality measures are improving or deteriorating can help health systems prioritize quality improvement initiatives. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Steven Habbous
- Ontario Health (Strategic Analytics), Toronto, Ontario, Canada
- Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Maggie Ford
- Ontario Health (Clinical Institutes and Quality Programs), Toronto, Ontario, Canada
| | - Stacey Bar-Ziv
- Ontario Health (Clinical Institutes and Quality Programs), Toronto, Ontario, Canada
| | - Terri Donovan
- Ontario Health (Clinical Institutes and Quality Programs), Toronto, Ontario, Canada
| | - Erik Hellsten
- Ontario Health (Strategic Analytics), Toronto, Ontario, Canada
| |
Collapse
|
2
|
Charalambous A, Pincus D, High S, Leung FH, Aktar S, Paterson JM, Redelmeier DA, Ravi B. Association of Surgical Experience With Risk of Complication in Total Hip Arthroplasty Among Patients With Severe Obesity. JAMA Netw Open 2021; 4:e2123478. [PMID: 34468752 PMCID: PMC8411295 DOI: 10.1001/jamanetworkopen.2021.23478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Severe obesity is a risk factor for major early complications after total hip arthroplasty (THA). OBJECTIVE To determine the association between surgeon experience with THA in patients with severe obesity and risk of complications. DESIGN, SETTING, AND PARTICIPANTS This retrospective population-based cohort study was performed in Ontario, Canada, from April 1, 2007, to March 31, 2017, with data analysis performed from March 2020 to January 2021. A cohort of patients who received a primary THA for osteoarthritis and who also had severe obesity (body mass index [calculated as weight in kilograms divided by height in meters squared] ≥40) at the time of surgery was defined. These patients were identified using the Canadian Institute for Health Information Discharge Abstract Database and physician claims from the Ontario Health Insurance Plan. Generalized estimating equations were used to determine the association between overall THA and severe obesity-specific THA surgeon volume and the occurrence of complications after controlling for potential confounders. The study hypothesized that surgeon experience specific to patients with severe obesity could further reduce the risk of complications. EXPOSURES Primary THA. MAIN OUTCOMES AND MEASURES Complications were considered as a composite outcome (revision, infection requiring surgery, or dislocation requiring reduction), within 1 year of surgery. This was defined before the study, as was the study hypothesis. RESULTS A total of 4781 eligible patients was identified. The median age was 63 (interquartile range [IQR], 56-69) years, and 3050 patients (63.8%) were women. Overall, 186 patients (3.9%) experienced a surgical complication within 1 year of surgery. The median overall THA surgeon volume was 70 (IQR, 46-106) cases/y, whereas the median obesity-specific surgeon volume was 5 (IQR, 2-9) cases/y. After controlling for patient and hospital factors, greater obesity-specific THA surgeon volume (adjusted odds ratio per additional 10 cases, 0.65 [95% CI, 0.47-0.89]; P = .007), but not greater overall THA surgeon volume (adjusted odds ratio per 10 additional cases, 0.97 [95% CI, 0.93-1.02]; P = .24), was associated with a reduced risk of complication. CONCLUSIONS AND RELEVANCE Increased surgeon experience performing THA in patients with severe obesity was associated with fewer major surgical complications. These findings suggest that surgeon experience is required to mitigate the unique anatomical challenges posed by surgery in patients with severe obesity. Referral pathways for patients with severe obesity to surgeons with high obesity-specific THA volume should be considered.
Collapse
Affiliation(s)
- Alexander Charalambous
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Daniel Pincus
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sasha High
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fok-Han Leung
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suriya Aktar
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - J. Michael Paterson
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Donald A. Redelmeier
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Bheeshma Ravi
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Salata K, Almaghlouth I, Hussain MA, de Mestral C, Greco E, Aljabri BA, Mamdani M, Forbes TL, Verma S, Al-Omran M. Outcomes of abdominal aortic aneurysm repair among patients with rheumatoid arthritis. J Vasc Surg 2020; 73:1261-1268.e5. [PMID: 32950628 DOI: 10.1016/j.jvs.2020.08.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/15/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In the present study, we compared the outcomes of elective abdominal aortic aneurysm (AAA) repair in patients with and without rheumatoid arthritis (RA) stratified by the type of surgery. METHODS A retrospective population-based cohort study was conducted from 2003 to 2016. Linked administrative health data from Ontario, Canada were used to identify all patients aged ≥65 years who had undergone elective open or endovascular AAA repair during the study period. Patients were identified using validated procedure and billing codes and matching using propensity scores. The primary outcome was survival. The secondary outcomes were major adverse cardiovascular events (MACE)-free survival (defined as freedom from death, myocardial infarction, and stroke), reintervention, and secondary rupture. RESULTS Of 14,816 patients undergoing elective AAA repair, a diagnosis of RA was present for 309 (2.0%). The propensity-matched cohort included 234 pairs of RA and control patients. The matched cohort was followed up for a mean ± standard deviation of 4.93 ± 3.35 years, and the median survival was 6.76 and 7.31 years for the RA and control groups, respectively. Cox regression analysis demonstrated no statistically significant differences in the hazards for death, MACE, reintervention, or secondary rupture. Analysis of the differences in outcomes stratified by repair approach also showed no statistically significant differences in the hazards for death, MACE, reintervention, or secondary rupture. CONCLUSIONS We found no statistically significant differences in survival, MACE, reintervention, or secondary rupture among patients with RA undergoing elective AAA repair compared with controls. Further studies are required to evaluate the impact of comorbidities and antirheumatic medications on the outcomes of elective AAA repair.
Collapse
Affiliation(s)
- Konrad Salata
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ibrahim Almaghlouth
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; College of Medicine Research Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohamad A Hussain
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Elisa Greco
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Badr A Aljabri
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia.
| |
Collapse
|
4
|
Salata K, Hussain MA, de Mestral C, Greco E, Awartani H, Aljabri BA, Mamdani M, Forbes TL, Bhatt DL, Verma S, Al-Omran M. Population-based long-term outcomes of open versus endovascular aortic repair of ruptured abdominal aortic aneurysms. J Vasc Surg 2020; 71:1867-1878.e8. [DOI: 10.1016/j.jvs.2019.06.212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 06/11/2019] [Indexed: 12/22/2022]
|
5
|
Salata K, Abdallah FW, Hussain MA, de Mestral C, Greco E, Aljabri B, Mamdani M, Mazer CD, Forbes TL, Verma S, Al-Omran M. Short-term outcomes of combined neuraxial and general anaesthesia versus general anaesthesia alone for elective open abdominal aortic aneurysm repair: retrospective population-based cohort study †. Br J Anaesth 2020; 124:544-552. [PMID: 32216957 DOI: 10.1016/j.bja.2020.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/05/2020] [Accepted: 01/25/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Use of neuraxial anaesthesia for open abdominal aortic aneurysm repair is postulated to reduce mortality and morbidity. This study aimed to determine the 90-day outcomes after elective open abdominal aortic aneurysm repair in patients receiving combined general and neuraxial anaesthesia vs general anaesthesia alone. METHODS A retrospective population-based cohort study was conducted from 2003 to 2016. All patients ≥40 yr old undergoing open abdominal aortic aneurysm repair were included. The propensity score was used to construct inverse probability of treatment weighted regression models to assess differences in 90-day outcomes. RESULTS A total of 10 447 elective open abdominal aortic aneurysm repairs were identified; 9003 (86%) patients received combined general and neuraxial anaesthesia and 1444 (14%) received general anaesthesia alone. Combined anaesthesia was associated with significantly lower hazards for all-cause mortality (hazard ratio [HR]=0.47; 95% confidence interval [CI], 0.37-0.61) and major adverse cardiovascular events (HR=0.72; 95% CI, 0.60-0.86). Combined patients were at lower odds for acute kidney injury (odds ratio [OR]=0.66; 95% CI, 0.49-0.89), respiratory failure (OR=0.41; 95% CI, 0.36-0.47), and limb complications (OR=0.30; 95% CI, 0.25-0.37), with higher odds of being discharged home (OR=1.32; 95% CI, 1.15-1.51). Combined anaesthesia was also associated with significant mechanical ventilation and ICU and hospital length of stay benefits. CONCLUSIONS Combined general and neuraxial anaesthesia in elective open abdominal aortic aneurysm repair is associated with reduced 90-day mortality and morbidity. Neuraxial anaesthesia should be considered as a routine adjunct to general anaesthesia for elective open abdominal aortic aneurysm repair.
Collapse
Affiliation(s)
- Konrad Salata
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Faraj W Abdallah
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anaesthesia, University of Ottawa, Ottawa, ON, Canada; Department of Anaesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mohamad A Hussain
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Elisa Greco
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Badr Aljabri
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training (CHART), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana Faculty of Public Health, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences at Sunnybrook Hospital, Toronto, ON, Canada
| | - C David Mazer
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anaesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network and Toronto, University of Toronto, ON, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Surgery, King Saud University, Riyadh, Saudi Arabia.
| |
Collapse
|
6
|
Salata K, Hussain MA, de Mestral C, Greco E, Aljabri BA, Mamdani M, Forbes TL, Bhatt DL, Verma S, Al-Omran M. Comparison of Outcomes in Elective Endovascular Aortic Repair vs Open Surgical Repair of Abdominal Aortic Aneurysms. JAMA Netw Open 2019; 2:e196578. [PMID: 31290986 PMCID: PMC6624804 DOI: 10.1001/jamanetworkopen.2019.6578] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Knowledge regarding the long-term outcomes of elective treatment of abdominal aortic aneurysm (AAA) using endovascular aortic repair (EVAR) is increasing. However, data with greater than 10 years' follow-up remain sparse and are lacking from population-based studies. OBJECTIVE To determine the long-term outcomes of EVAR compared with open surgical repair (OSR) for elective treatment of AAA. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based cohort study used linked administrative health data from Ontario, Canada, to identify all patients 40 years and older who underwent elective EVAR or OSR for AAA repair from April 1, 2003, to March 31, 2016, with follow-up terminating on March 31, 2017. A total of 17 683 patients were identified using validated procedure and billing codes and were propensity score matched. Analysis was conducted from June 26, 2018, to January 16, 2019. EXPOSURES Elective EVAR or OSR for AAA. MAIN OUTCOMES AND MEASURES The primary outcome was overall survival. Secondary outcomes were major adverse cardiovascular event-free survival, defined as being free of death, myocardial infarction, or stroke; reintervention; and secondary rupture. RESULTS Among 17 683 patients who received elective AAA repairs (mean [SD] age, 72.6 [7.8] years; 14 286 [80.8%] men), 6100 (34.5%) underwent EVAR and 11 583 (65.5%) underwent OSR. From these patients, 4010 well-balanced propensity score-matched pairs of patients were defined, with a mean (SD) age of 73.0 (7.6) years and 6583 (82.1%) men. In the matched cohort, the mean (SD) follow-up was 4.4 (2.7) years, and maximum follow-up was 13.8 years. The overall median survival was 8.9 years. Compared with OSR, EVAR was associated with a higher survival rate up to 1 year after repair (91.0% [95% CI, 90.1%-91.9%] vs 94.0% [95% CI, 93.3%-94.7%]) and a higher major adverse cardiovascular event-free survival rate up to 4 years after repair (69.9% [95% CI, 68.3%-71.3%] vs 72.9% [95% CI, 71.4%-74.4%]). Cumulative incidence of reintervention was higher among patients who underwent EVAR compared with those who underwent OSR at the 7-year follow-up (45.9% [95% CI, 44.1%-47.8%] vs 42.2% [95% CI, 40.4%-44.0%]). Survival analyses demonstrated no statistically significant differences in long-term survival, reintervention, and secondary rupture for patients who underwent EVAR compared with those who underwent OSR. Kaplan-Meier analysis suggested superior long-term major adverse cardiovascular event-free survival among patients who underwent EVAR compared with those who underwent OSR (32.6% [95% CI, 26.9%-38.4%] vs 14.1% [95% CI, 4.0%-30.4%]; stratified log-rank P < .001) during a maximum follow-up of 13.8 years. CONCLUSIONS AND RELEVANCE Endovascular aortic repair was not associated with a difference in long-term survival during more than 13 years' maximum follow-up. The reasons for these findings will require studies to consider specific graft makes and models, adherence to instructions for use, and types and reasons for reintervention.
Collapse
Affiliation(s)
- Konrad Salata
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Mohamad A. Hussain
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Elisa Greco
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Badr A. Aljabri
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training (CHART), Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Thomas L. Forbes
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Subodh Verma
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
7
|
de Mestral C, Kayssi A, Al-Omran M, Salata K, Hussain MA, Roche-Nagle G. Home care nursing after elective vascular surgery: an opportunity to reduce emergency department visits and hospital readmission. BMJ Qual Saf 2019; 28:901-907. [DOI: 10.1136/bmjqs-2018-009161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 01/27/2023]
Abstract
BackgroundEvents occurring outside the hospital setting are underevaluated in surgical quality improvement initiatives and research.ObjectiveTo quantify regional variation in home care nursing following vascular surgery and explore its impact on emergency department (ED) visits and hospital readmission.MethodsPatients who underwent elective vascular surgery and were discharged directly home were identified from population-based administrative databases for the province of Ontario, Canada, 2006–2015. The index surgeries included carotid endarterectomy, open and endovascular aortic aneurysm repair and bypass for lower extremity peripheral arterial disease. Home care nursing within 30 days of discharge was captured and compared across regions. Using multilevel logistic regression, we characterised the association between home care nursing and the risk of an ED visit or hospital readmission within 30 days of discharge.ResultsThe cohort included 23 617 patients, of whom 9002 (38%) received home care nursing within 30 days of discharge home. Receipt of nursing care after discharge home varied widely across Ontario’s 14 administrative health regions (range 16%–84%), even after accounting for differences in patient case mix. A lower likelihood of an ED visit or hospital readmission within 30 days of discharge was observed among patients who received home care nursing following three of four index surgeries: carotid endarterectomy OR 0.74, 95% CI 0.61 to 0.91; endovascular aortic aneurysm repair OR 0.85, 95% CI 0.72 to 0.99; open aortic aneurysm repair OR 1.06, 95% CI 0.91 to 1.23; bypass for lower extremity peripheral arterial disease OR 0.81, 95% CI 0.72 to 0.92.ConclusionHome care nursing may contribute to reducing ED visits and hospital readmission and is variably prescribed after vascular surgery.
Collapse
|
8
|
Salata K, Hussain MA, de Mestral C, Greco E, Aljabri BA, Sabongui S, Mamdani M, Forbes TL, Bhatt DL, Verma S, Al-Omran M. Trends in elective and ruptured abdominal aortic aneurysm repair by practice setting in Ontario, Canada, from 2003 to 2016: a population-based time-series analysis. CMAJ Open 2019; 7:E379-E384. [PMID: 31147379 PMCID: PMC6544505 DOI: 10.9778/cmajo.20180173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recent years have seen centralization of vascular surgery services in Ontario. We sought to examine the trends in overall and approach-specific elective and ruptured abdominal aortic aneurysm repair by hospital type (teaching v. community). METHODS We conducted a population-based time-series analysis of elective and ruptured abdominal aortic aneurysm repairs in Ontario, Canada, from 2003 to 2016. Quarterly cumulative incidences of repairs per 100 000 Ontarians aged 40 years and older were calculated. We fit exponential smoothing models to the data stratified by approach and hospital type to examine repair trends. RESULTS We identified 19 219 elective and 2722 ruptured repairs between 2003 and 2016. The cumulative incidences of overall elective repair and elective open surgical repair decreased by 1.15% (p = 0.008) and 67% (p < 0.001), respectively, in teaching hospitals and by 23% (p < 0.001) and 60% (p < 0.001), respectively, in community hospitals. The cumulative incidence of elective endovascular repair increased 667% in teaching hospitals (p < 0.001). Elective endovascular repair began in community centres after 2010 and increased to 0.98/100 000 (p < 0.001), resulting in a rebound in overall elective repair in the community. Overall ruptured repairs and ruptured open repairs decreased by 84% (p < 0.001) and 88% (p = 0.002), respectively, at community hospitals. Ruptured endovascular repairs at community hospitals increased from no procedures before 2006 to 0.03/100 000 in 2016 (p = 0.005). INTERPRETATION There has been substantial uptake of endovascular aortic repair in teaching and community hospitals in Ontario, and community hospital uptake of endovascular repair has begun decentralization of abdominal aortic aneurysm repair. Increased experience and training in endovascular repair and reduced specialized care requirements will probably lead to continued decentralization.
Collapse
Affiliation(s)
- Konrad Salata
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Mohamad A Hussain
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Charles de Mestral
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Elisa Greco
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Badr A Aljabri
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Sandra Sabongui
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Muhammad Mamdani
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Thomas L Forbes
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Deepak L Bhatt
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Subodh Verma
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Mohammed Al-Omran
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.
| |
Collapse
|
9
|
Salata K, Hussain MA, Mestral CD, Greco E, Mamdani M, Tu JV, Forbes TL, Bhatt DL, Verma S, Al-Omran M. The impact of randomized trial results on abdominal aortic aneurysm repair rates from 2003 to 2016: A population-based time-series analysis. Vascular 2019; 27:417-426. [DOI: 10.1177/1708538119829582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives The uptake of endovascular aortic repair for elective and ruptured abdominal aortic aneurysm repair is not well studied. We aimed to examine the trends in open surgical repair and endovascular aortic repair of eAAA and rAAA and to examine the effects of randomized trial publications on elective open surgical repair and endovascular aortic repair rates. Methods We conducted a population-based time-series analysis of eAAA and rAAA repairs in Ontario, Canada from 2003 to 2016. We examined changes in overall and approach-specific rates of eAAA and rAAA repair using exponential smoothing models. Interventional autoregressive integrated moving average models were fit to the eAAA rates to examine the impact of randomized trial results on these rates. Results We identified 19,489 eAAA (12,232 open (63%) and 7257 endovascular (37%)) and 2732 rAAA (2466 open (90%) and 266 endovascular (10%)) repairs from 2003 to 2016. The rate of eAAA repair declined from 6.39/100,000 in 2003 to 5.59/100,000 in 2016 (13% decrease, p = 0.17). The rate of elective open surgical repair decreased nearly three-fold from 6.07/100,000 to 2.12/100,000 ( p < 0.0001), while elective endovascular aortic repair increased approximately 10-fold (0.32/100,000 to 3.47/100,000, p < 0.0001). The rate of ruptured open surgical repair decreased from 1.62/100,000 to 0.37/100,000 ( p < 0.44), while ruptured endovascular aortic repair uptake increased (0.00/100,000 to 0.12/100,000, p < 0.25). The mid-term results of the DREAM and EVAR-1 trials were associated with a decrease in the rate of elective open surgical repair decline after 2010 ( p = 0.01). Conclusions While elective open surgical repair use has significantly decreased from 2003 to 2016, elective endovascular aortic repair use has significantly increased. The DREAM and EVAR-1 results significantly impacted the observed rates of elective open surgical repair only. The reasons for these trends require further characterization.
Collapse
Affiliation(s)
- Konrad Salata
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Mohamad A Hussain
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Elisa Greco
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training (CHART), Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana Faculty of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences at Sunnybrook Hospital, Toronto, ON, Canada
| | - Jack V Tu
- Institute of Health Policy, Management and Evaluation, Dalla Lana Faculty of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences at Sunnybrook Hospital, Toronto, ON, Canada
- Division of Cardiology, Department of Medicine, Schulich Heart Program, Sunnybrook Hospital, Toronto, ON, Canada
- Schulich Heart Research Program, Sunnybrook Research Institute at Sunnybrook Hospital, Toronto, ON, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Subodh Verma
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
10
|
Salata K, Hussain MA, de Mestral C, Greco E, Mamdani M, Forbes TL, Bhatt DL, Verma S, Al-Omran M. Prevalence of Elective and Ruptured Abdominal Aortic Aneurysm Repairs by Age and Sex From 2003 to 2016 in Ontario, Canada. JAMA Netw Open 2018; 1:e185418. [PMID: 30646400 PMCID: PMC6324588 DOI: 10.1001/jamanetworkopen.2018.5418] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Age and sex are important considerations in assessing and individualizing therapy for abdominal aortic aneurysm (AAA) repair. OBJECTIVE To determine the prevalence of open and endovascular elective AAA (EAAA) and ruptured AAA (RAAA) repair by age and sex. DESIGN, SETTING, AND PARTICIPANTS In this retrospective, population-based, cross-sectional, time-series analysis in Ontario, Canada, from April 1, 2003, to March 31, 2016, all patients undergoing AAA repair who were older than 39 years were included. EXPOSURES Elective AAA and RAAA repair with open surgical repair (OSR) or endovascular aortic repair (EVAR). MAIN OUTCOMES AND MEASURES Age- and sex-standardized rates of EAAA and RAAA repair with OSR and EVAR. RESULTS From 2003 to 2016, 19 489 EAAA repairs (12 232 [63%] OSR and 7257 [37%] EVAR) and 2732 RAAA repairs (2466 [90%] OSR and 266 [10%] EVAR) were identified. The mean (SD) age was 72.7 (8.1) years in the EAAA subgroup and 73.5 (8.9) years in the RAAA subgroup; 15 813 patients (81%) in the EAAA subgroup and 2178 (80%) in the RAAA subgroup were men. The rates of EAAA by age quintile and sex decreased over the study period except among patients older than 79 years (1.3 per 100 000 population in 2003 to 2.2 per 100 000 population in 2016; 70% increase; P < .001). The rates of elective OSR decreased across all age and sex subgroups (range, 38%-74% decrease; P ≤ .009 for all subgroups) except among patients older than 79 years (1.3 per 100 000 population at baseline to 0.56 per 100 000 population in the second quarter of 2016; 53% decrease; P = .05). The rates of elective EVAR significantly increased across all age and sex subgroups (range, 566%-1585% increase; P ≤ .04 for all subgroups). Elective EVAR became the dominant treatment approach for aneurysms in men around 2010, whereas it maintained parity among women in 2016. The RAAA repair rate decreased over the study period in all subgroups (range, 32%-91% decrease; P ≤ .001 for all subgroups), but the decrease was not significant among women (80% decrease; P = .08). Similarly, the rates of ruptured OSR decreased among all subgroups (range, 47%-91% decrease; P < .001), but the decrease was not significant among women (87% decrease; P = .54). Ruptured EVAR showed significant uptake in all subgroups. CONCLUSIONS AND RELEVANCE Among patients with AAA in Ontario, Canada, use of EVAR appeared to increase from 2003 to 2016, whereas OSR use appeared to decrease. These findings were most pronounced among elective procedures for men and older patients. The delayed increase in the use of EVAR among women may reflect continued anatomical constraints for women seeking elective repair.
Collapse
Affiliation(s)
- Konrad Salata
- Department of Surgery, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Mohamad A. Hussain
- Department of Surgery, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Charles de Mestral
- Department of Surgery, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Elisa Greco
- Department of Surgery, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training, Li Ka Shing Knowledge Institute, St Michael’s Hospital Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana Faculty of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Thomas L. Forbes
- Department of Surgery, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Subodh Verma
- Department of Surgery, Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Mohammed Al-Omran
- Department of Surgery, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|