Rivascolarizzazione carotidea con endoarteriectomia: volume annuale di interventi chirurgici


Indice

Descrizione indicatore

L’indicatore ci consente di calcolare il numero di interventi chirurgici di rivascolarizzazione carotidea con endoarteriectomia eseguiti in un anno in una struttura ospedaliera (indicatore di "volume").

Come si legge

L’indicatore si riferisce al grado di "competenza" e di "sicurezza" delle cure prestate. 
Più alto è il numero di interventi chirurgici di rivascolarizzazione carotidea con endoarteriectomia eseguiti in una struttura ospedaliera, maggiore è il grado di esperienza della struttura stessa e la sicurezza del trattamento offerto.

Descrizione generale

Le patologie più frequenti che colpiscono i grandi vasi del collo sono rappresentate da restringimenti o ostruzioni causate da placche aterosclerotiche (accumuli di colesterolo circondati da cellule e fibrosi). 
Queste patologie causano un ridotto afflusso di sangue alle strutture cerebrali e, quindi, patologie come l’attacco ischemico transitorio o ictus. Tali restringimenti o ostruzioni possono essere trattati chirurgicamente mediante l'endoarteriectomia, un intervento chirurgico che consente, attraverso una incisione chirurgica del collo e poi della parete dell’arteria carotide, di rimuovere un tratto della parete interna del vaso (tunica intima) colpito da placche aterosclerotiche e/o trombosi.

Valutazione istituzionale

Il Gruppo di lavoro del Programma Nazionale Esiti ha identificato la seguente soglia minima di volume di attività: 75 procedure/anno.

Codici ICD-9-CM selezionati

Sono inclusi tutti i ricoveri, in regime ordinario, con i codici ICD-9-CM di intervento 38.10, 38.11, 38.12 (endoarteriectomia di vasi intracranici e di altri vasi del capo e del collo) in qualunque posizione.

Il volume di ricoveri per interventi chirurgici è calcolato su base annuale, riferito all’anno di dimissione del ricovero.

Consulta le strutture sanitarie che effettuano in un anno il maggior numero di interventi chirurgici di rivascolarizzazione carotidea con endoarteriectomia

Fonte del dato

Programma Nazionale Esiti 2018, indicatore 119. 
Confronto tra strutture calcolato su dati 2017.

Nota bene: per tener conto di errori di attribuzione, sono escluse dall'analisi le strutture con volumi di attività molto bassi (min 5/anno).
Come riportato nel documento elaborato dal PNE, la definizione dell’esposizione sulla base dei volumi della struttura piuttosto che dell’unità operativa potrebbe essere soggetta a misclassificazione.

Fonte della Valutazione Istituzionale

Il semaforo è calcolato sulla base del seguente documento ufficiale:

Altre fonti scientifiche

  • Holt PJ, Poloniecki JD, Loftus IM, Thompson MM. Meta-analysis and systematic review of the relationship between hospital volume and outcome following carotid endarterectomy. Eur J Vasc Endovasc Surg 2007;33(6):645-51. 
  • Killeen SD, Andrews EJ, Redmond HP, Fulton GJ. for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures. J Vasc Surg 2007;45(3):615-26.
  • Gandjour A, Bannerberg A, Lauterbach KW. Threshold volumes associated with higher survival in health care. Med Care 2003;41(10):1129-41.
  • Halm EA, Lee C, Chassin MR. Is volume related to outcome in healthcare? Asystematic review and methodologic critique of the literature. Ann Intern Med 2002:137(6):511-20.
  • Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 2000; 283(9):1159-66.
  • AbuRahma AF, Boland J, Robinson P. Complications of carotid endarterectomy: the influence of case load. South Med J 1988;81(6):711-15.
  • Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl JMed 2002;346(15):1128-37.
  • Brook RH, Park RE, ChassinMR, Kosecoff J, Keesey J, Solomon DH. Carotid endarterectomy for elderly patients: predicting complications. Ann Intern Med 1990;113(10):747-53.
  • Brott T, Thalinger K. The practice of carotid endarterectomy in a large metropolitan area. Stroke 1984;15(6):950-55.
  • Cebul RD, Snow RJ, Pine R, Hertzer NR, Norris DG. Indications, outcomes, and provider volumes for carotid endarterectomy. JAMA 1998;279(16):1282-87.
  • Cowan JA Jr, Dimick JB, Thompson BG, Stanley JC, Upchurch GR Jr. Surgeon volume as an indicator of outcomes after carotid endarterectomy: an effect independent of specialty practice and hospital volume. J Am Coll Surg 2002;195(6):814-21.
  • Dardik A, Bowman HM, Gordon TA, Hsieh G, Perler BA. Impact of race on the outcome of carotid endarterectomy: a population-based analysis of 9,842 recent elective procedures. Ann Surg 2000;232(5):704-09.
  • Dimik JB, Stanley JC, Axelrod DA et al. Variation in death rate after abdominal aortic aneurysmectomy in the United States: impact of hospital volume, gender, and age. Ann Surg 2002;235(4):579-85.
  • Dudley RA, Johansen Kl, Brand R, Rennie DJ, Milstein A. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 2000;283(9):1159-66.
  • Edwards WH, Morris JA Jr, Jenkins JM, Bass SM, MacKenzie EJ. Evaluating quality, cost-effective health care. Vascular database predicated on hospital discharge abstracts. Ann Surg 1991;213(5):433-38; discussion 438-39.
  • Feasby Te, Quan H, Ghali WA. Hospital and surgeon determinants of carotid endarterectomy outcomes. Arch Neurol 2002;59(12):1877-81.
  • Fisher ES,Malenka DJ, Solomon NA, Bubolz TA, Whaley FS, Wennberg JE. Risk of carotid endarterectomy in the elderly. Am J Public Health 1989;79(12):1617-20.
  • Hannan EL, Popp AJ, Tranmer B, Fuestel P, Waldman J, Shah D. Relationship between provider volume and mortality for carotid endarterectomies in New York state. Stroke 1998;29(11):2292-97.
  • Hannan EL, Popp AJ, Feustel P et al. Association of surgical specialty and processes of care with patient outcomes for carotid endarterectomy. Stroke 2001;32(12):2890-97. 
  • Hartun NL, Kongable GL, Baglioni AJ, Meakem TD, Kron IL. Examination of sex as an independent risk factor for adverse events after carotid endarterectomy. J Vasc Surg 2005;41(2):223-30.
  • Hsia DC, Moscoe LM, Krushat WM. Epidemiology of carotid endarterectomy among Medicare beneficiaries: 1985-1996 update. Stroke 1998;29(2):346-50. 
  • Kantonen I, Lepantalo M, Salenius JP, Matzke S, Luther M, Ylonen K. Mortality in abdominal aortic aneurysm surgery – the effect of hospital volume, patient mix and surgeon’s case load. Eur J Vasc Endovasc Surg 1997;14(5):375-79. 
  • Kantonen I, Lepantalo M, Salenius JP, Matzke S, Luther M, Ylonen K. Influence of surgical experience on the results of carotid surgery. The Finnvasc Study Group. Eur J Vasc Endovasc Surg 1998;15(2):155-60.
  • Karp HR, Flanders WD, Shipp CC, Taylor B, Martin D. Carotid endarterectomy among Medicare beneficiaries: a statewide evaluation of appropriateness and outcome. Stroke 1998;29(1):46-52.
  • Kempezinski RF, Brott TG, Labutta RJ. The influence of surgical specialty and case- load on the results of carotid endarterectomy. J Vasc Surg 1986;3(6):911-16. 
  • Khuri SF, Daley J, Henderson W et al. Relation of surgical volume to outcome in eight common operations: results from the VA National Surgical Quality Improvement Program. Ann Surg 1999;230(3):414-29.
  • Kirshner DL, O’Brien MS, Ricotta JJ. Risk factors in a community experience with carotid endarterectomy. J Vasc Surg 1989;10(2):178-86.
  • Kucey DS, Bowyer B, Iron K, Austin P, Anderson G, Tu JV. Determinants of outcome after carotid endarterectomy. J Vasc Surg 1998;28(6):1051-58.
  • Manheim LM, Sohn MW, Feinglass J, Ujiki M, Parker MA, Pearce WH. Hospital vascular surgery volume and procedure mortality rates in California, 1982-1994. J Vasc Surg 1998;28(1):45-56; discussion 56-58.
  • Mattos MA, Modi JR, Mansour AM et al. Evolution of carotid endarterectomy in two community hospitals: Springfield revisited – seventeen years and 2243 operations later. J Vasc Surg 1995;21(5):719-26; discussion 726-28.
  • Mayo SW, Eldrup-Jorgensen J, Lucas FL, Wennberg DE, Bredenberg CE. Carotid endarterectomy after NASCET and ACAS: a statewide study. North American Symptomatic Carotid Endarterectomy Trial. Asymptomatic Carotid Artery Stenosis Study. J Vasc Surg 1998;27(6):1017-22; discussion 1022-23.
  • Middleton S, Donnelly N; New SouthWales Carotid Endarterctomy Audit Project Working Group. Outcomes of carotid endarterectomy: how does the Australian state of New SouthWales compare with international benchmarks? J Vasc Surg 2002;36(1):62-69.
  • O’Neill L, Lanska DJ, Hartz A. Surgeon characteristics associated with mortality and morbidity following carotid endarterectomy. Neurology 2000;55(6):773-81.
  • Pearce WH, Parker MA, Feinglass J, Ujiki M, Manheim LM. The importance of surgeon volume and training in outcomes for vascular surgical procedure. J Vasc Surg 1999;29(5):768-76; discussion 777-78.
  • Peck C, Peck J, Peck A. Comparison of carotid endarterectomy at high- and low-volume hospitals. Am J Surg 2001;181(5):450-53.
  • Perler BA, Dardik A, Burleyson GP, Gordon TA, Williams GM. Influence of age and hospital volume on the results of carotid endarterectomy: a statewide analysis of 9918 cases. J Vasc Surg 1998;27(1):25-31; discussion 31-33.
  • Richardson JD, Main KA. Carotid endarterectomy in the elderly population: a statewide experience. J Vasc Surg 1989;9(1):65-73.
  • Roddy SP, O’Donnell TF Jr, Wilson AL, Estes JM, Mackey WC. The Balanced Budget Act: potential implications for the practice of vascular surgery. J Vasc Surg 2000;31(2):227-36.
  • Ruby ST, Robinson D, Lynch JT, Mark H. Outcome analysis of carotid endarterectomy in Connecticut: the impact of volume and specialty. Ann Vasc Surg 1996;10(1):22-26.
  • Segal HE, Rummel L, Wu B. The utility of PRO data on surgical volume: the example of carotid endarterectomy. QRB Qual Rev Bull 1993;19(5):152-57.
  • Wennberg DE, Lucas FL, Birkmeyer JD, Bredenberg CE, Fisher ES. Variation in carotid endarterectomy mortality in the Medicare population: trial hospitals, volume, and patient characteristics. JAMA 1998;279(16):1278-81
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