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dc.contributor.authorGoodney, Philip P.
dc.contributor.authorSchanzer, Andres
dc.contributor.authorDeMartino, Randall R.
dc.contributor.authorNolan, Brian W.
dc.contributor.authorHevelone, Nathanael
dc.contributor.authorConte, Michael S.
dc.contributor.authorPowell, Richard J.
dc.contributor.authorCronenwett, Jack L.
dc.contributor.authorVascular Study Group of New England
dc.date2022-08-11T08:10:58.000
dc.date.accessioned2022-08-23T17:27:01Z
dc.date.available2022-08-23T17:27:01Z
dc.date.issued2011-02-22
dc.date.submitted2011-06-20
dc.identifier.citationJ Vasc Surg. 2011 Feb 17. <a href="http://dx.doi.org/10.1016/j.jvs.2010.11.107">Link to article on publisher's site</a>
dc.identifier.issn0741-5214 (Linking)
dc.identifier.doi10.1016/j.jvs.2010.11.107
dc.identifier.pmid21334173
dc.identifier.urihttp://hdl.handle.net/20.500.14038/49765
dc.description.abstractBACKGROUND: To develop standardized metrics for expected outcomes in lower extremity revascularization for critical limb ischemia (CLI), the Society for Vascular Surgery (SVS) has developed objective performance goals (OPGs) based on aggregate data from randomized trials of lower extremity bypass (LEB). It remains unknown, however, if these targets can be achieved in everyday vascular surgery practice. METHODS: We applied SVS OPG criteria to 1039 patients undergoing 1039 LEB operations for CLI with autogenous vein (excluding patients on dialysis) within the Vascular Study Group of New England (VSGNE). Each of the individual OPGs was calculated within the VSGNE dataset, along with its surrounding 95% confidence intervals (CIs) and compared to published SVS OPGs using chi(2) comparisons and survival analysis. RESULTS: Across most risk strata, patients in the VSGNE and SVS OPG cohorts were similar (clinical high-risk [age >80 years and tissue loss]: 15.3% VSGNE; 16.2% SVS OPG; P = .58; anatomic high risk [infrapopliteal target artery]: 57.8% VSGNE; 60.2% SVS OPG; P = .32). However, the proportion of VSGNE patients designated as conduit high-risk (lack of single-segment great saphenous vein) was lower (10.2% VSGNE; 26.9% SVS OPG;P < .001). The primary safety endpoint, major adverse limb events (MALE) at 30 days, was lower in the VSGNE cohort (3.2%; 95% CI, 2.3-4.6) than the SVS OPG cohort (6.2%; 95% CI, 4.2-8.1; P = .05). The primary efficacy OPG endpoint, freedom from any MALE or postoperative death within the first year (MALE + postoperative death [POD]), was similar between VSGNE and SVS OPG cohorts (77%; 95% CI, 74%-80%) SVS OPG, 74% (95% CI, 71%-77%) VSGNE, P = .58). In the remaining safety and efficacy OPGs, the VSGNE cohort met or exceeded the benchmarks established by the SVS OPG cohort. CONCLUSION: Community and academic centers in everyday vascular surgery practice can meet OPGs derived from centers of excellence in LEB. Quality improvement initiatives, as well as clinical trials, should incorporate OPGs in their outcome measures to facilitate communication and comparison of risk-adjusted outcomes in the treatment of CLI. All rights reserved.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=21334173&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.jvs.2010.11.107
dc.subjectVascular Surgical Procedures
dc.subjectOutcome and Process Assessment (Health Care)
dc.subjectQuality Indicators, Health Care
dc.subjectSurgery
dc.titleValidation of the Society for Vascular Surgery's Objective Performance Goals for critical limb ischemia in everyday vascular surgery practice
dc.typeJournal Article
dc.source.journaltitleJournal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/surgery_pp/34
dc.identifier.contextkey2067737
html.description.abstract<p>BACKGROUND: To develop standardized metrics for expected outcomes in lower extremity revascularization for critical limb ischemia (CLI), the Society for Vascular Surgery (SVS) has developed objective performance goals (OPGs) based on aggregate data from randomized trials of lower extremity bypass (LEB). It remains unknown, however, if these targets can be achieved in everyday vascular surgery practice.</p> <p>METHODS: We applied SVS OPG criteria to 1039 patients undergoing 1039 LEB operations for CLI with autogenous vein (excluding patients on dialysis) within the Vascular Study Group of New England (VSGNE). Each of the individual OPGs was calculated within the VSGNE dataset, along with its surrounding 95% confidence intervals (CIs) and compared to published SVS OPGs using chi(2) comparisons and survival analysis.</p> <p>RESULTS: Across most risk strata, patients in the VSGNE and SVS OPG cohorts were similar (clinical high-risk [age >80 years and tissue loss]: 15.3% VSGNE; 16.2% SVS OPG; P = .58; anatomic high risk [infrapopliteal target artery]: 57.8% VSGNE; 60.2% SVS OPG; P = .32). However, the proportion of VSGNE patients designated as conduit high-risk (lack of single-segment great saphenous vein) was lower (10.2% VSGNE; 26.9% SVS OPG;P < .001). The primary safety endpoint, major adverse limb events (MALE) at 30 days, was lower in the VSGNE cohort (3.2%; 95% CI, 2.3-4.6) than the SVS OPG cohort (6.2%; 95% CI, 4.2-8.1; P = .05). The primary efficacy OPG endpoint, freedom from any MALE or postoperative death within the first year (MALE + postoperative death [POD]), was similar between VSGNE and SVS OPG cohorts (77%; 95% CI, 74%-80%) SVS OPG, 74% (95% CI, 71%-77%) VSGNE, P = .58). In the remaining safety and efficacy OPGs, the VSGNE cohort met or exceeded the benchmarks established by the SVS OPG cohort.</p> <p>CONCLUSION: Community and academic centers in everyday vascular surgery practice can meet OPGs derived from centers of excellence in LEB. Quality improvement initiatives, as well as clinical trials, should incorporate OPGs in their outcome measures to facilitate communication and comparison of risk-adjusted outcomes in the treatment of CLI. All rights reserved.</p>
dc.identifier.submissionpathsurgery_pp/34
dc.contributor.departmentDepartment of Surgery


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