Abstract 16031: Aligning Information Technology With Longitudinal Outcomes Surveillance: A Multiregional Vascular Registry Experience
Objective: A Registry developed by a community based integrated healthcare system tracks all patients undergoing Endovascular Aortic Aneurysm Repair (EVAR) to monitor surgical complications, examine clinical practice and assess device performance. The study purpose was to describe data collection, outcomes validation and on-going surveillance, highlighting the integration of information technology with clinical operations.
Methods: The Registry includes all EVARs performed from 1/2010 to present in 5 geographical regions of a 9 million member U.S. health plan. Cases are imported into the Registry using a screening algorithm of inpatient codes applied to the Electronic Medical Record (EMR). Using standardized forms in the EMR, surgeons document pertinent pre-, post- and operative data. For each consecutive EVAR case, patient co-morbidities, graft details, aneurysm characteristics, and surgical outcomes (e.g., infection, endoleak, rupture, device malfunction, re-intervention) are adjudicated in the EMR. All patients in the Registry are followed for life in the system, all relevant events captured.
Descriptive statistics for 2010-2011 are included.
Results: The Registry recorded 1068 EVARs: 1005 primary, 63 revision. Mean aneurysm size was 5.75 cm (2.0-14.0). The majority of patients were male (84%), smokers (75%), with hypertension (83%) and hyperlipidemia (78%). Minimum follow-up was 1 year. Infection and rupture were infrequent (0.09%). Occurrence of Type 2 endoleaks was 20%; endoleaks Types 1 and 3 combined were 3.4%. Device malfunction was noted in 3.8% of cases. Overall re-intervention rate was 10.3%: conversion to open repair 1.3%, EVAR revision 2.4%, all other re-interventions 6.6%. One-year all-cause mortality was 14.3%.
Conclusion: Registry alignment with EMR offers a robust platform for monitoring short and long-term outcomes after AAA repair. Assessment of device performance, practice variation and post-operative outcomes benefits clinical decision making in an integrated health care system by providing complete and adjudicated event reporting. Longitudinal findings from this large, community-based EVAR Registry augment other studies that are limited to inpatient acute complications or small patient cohorts.
- © 2013 by American Heart Association, Inc.