Clinical Governance for Vascular Surgery in the North West

Transcription

1 Clinical Governance for Vascular Surgery in the North West Annual Report 26/27 July 27 Clinical Audit Department Education and Research Centre South Manchester University Hospital Southmoor Road Manchester M23 9LT

2 1 Contents Contents Summary Progress in 26/ Planned work for 27/ Introduction Background Aims and objectives of the project Clinical Governance Advisory Committee Changes to the structure of the Steering Committee North West vascular standards Appraisal and revalidation Improving Data Quality Data validation Risk scoring Ongoing Issues Work during the reporting period Website Vascular Society links Audits General methodology Sample and dates Data collection and transfer Communication of results Carotid Endarterectomy Abdominal Aortic Aneurysm Amputation Audit Peripheral Bypass Register Smoking Cessation Audit Contact List of Appendices...31

3 2 2 Summary 2.1 Progress in 26/27 As of June 27 the databases included: Audits 395 carotid endarterectomy (CEA) records 237 abdominal aortic aneurysm (AAA) records 15 amputation records 45 bypass registers Continued data collection and analysis of the two index vascular procedures: we now have over 5 records in our databases. Performance in both CEA and AAA meet evidence-based standards We continue to make a significant contribution to the national vascular dataset, with nearly 4% of national data held by the Vascular Surgical Society (VSS) submitted via our programme. The amputation audit was launched in 26. The peripheral bypass register was launched in January 27. The smoking cessation audit continues and we are now receiving follow up questionnaires. There is now good evidence that outcomes following carotid and AAA surgery have improved since VGNW was introduced. (see pages 21 & 29) Data validation process Over the last 12 months we have continued work on data validation, including: Missing data reports Are sent to surgeons showing where we have incomplete data, so the required information can be gathered and returned. Standard operation sheets Operation sheets covering carotid endarterectomy (CEA) and abdominal aortic aneurysm repair (AAA) were produced in 23/24. In 24/25 an operation sheet for endovascular aneurysm repair was also produced with the aim of more accurate and comprehensive data collection. (These are available on request from the audit team). Surgeon submissions A report was produced, showing the number of records submitted by each surgeon, each year, we are now able to use this to highlight surgeons who may not be returning all of there data. This will allow us to intervene earlier, and prevent backlogs of data.

4 3 2.2 Planned work for 27/28 Risk stratification We continue to work on a valid and reliable model for risk scoring. Three different approaches a multivariate model, a Bayes model and a neural network model are being considered to develop a risk-scoring model based on procedure-specific data. Regional standards we continue to use the standards agreed by the surgeons in the region for the two index procedures carotid endarterectomy and abdominal aotic aneurysm repair (for regional standards in carotid endarterectomy and elective abdominal aortic aneurysm repair, (see Appendix 2). We are also planning to look at new ways to measure performance. Continue the data validation process. Work has now started on performing an in depth data validation of three units. This will include the detailed analysis of HES data, and a comparison to surgeons submitted data. It is hoped that the outcome of this exercise will support our recent report showing how VGNW has improved clinical standards. Complete the prospective smoking cessation audit. The way we follow-up patients for this audit has been reviewed, and improvements have been made. We have now seen a dramatic increase in the number of follow-up forms we have received. To raise the profile of data collection on EVAR s performed in the region. As more surgeons have started to perform EVAR procedures, the number of returns has increased. We now need to contact all surgeons performing EVAR and offer our support. To raise the profile of data collection on amputation outcome in the region.

5 4 3 Introduction Vascular Governance North West began in 1999, and has expanded to include a range of disciplines working together to create the extensive database that we support today (see Appendix 1 for contributing surgeons). We now have over 5 records on two databases, and are aiming to continue the expansion of this audit while also improving the quality of our data. 3.1 Background The need to implement the quality agenda in specialist surgery was clearly identified following the Bristol inquiry. In April 1999 vascular surgeons in the North West (5 surgeons in 24 units) set up a peer led clinical governance initiative. The main function of the project is to collect and analyse procedure specific surgical data: Carotid endarterectomy (CEA) Abdominal aortic aneurysm (AAA) repair Amputation Local audit is also supported by providing surgeons with a benchmarking facility through which they can request ad hoc analyses of the anonymised regional data for comparison with their own results. All data is submitted to the Vascular Society of Great Britain and Ireland National vascular Database (NVD) and provides nearly 4% of their data. The project has also supplied carotid data to the nationwide UKCEA. An Advisory Committee has been elected following a ballot of all surgeons with a vascular interest in the North West. Members are elected for a three-year period with one individual reelected each year. This committee represents a positive step towards the implementation of clinical governance and can be approached at any time, in complete confidence, by surgeons, hospital managers or the audit team. The intention is to offer advice on standards or in the event that a surgeon s performance falls below accepted standards, investigate concerns thoroughly and impartially in order to make recommendations and hopefully prevent inappropriate suspension. A Steering Committee has also been formed which includes both surgeons and audit staff, and is responsible for the day to day running of the project. It meets four times a year to manage the audit programme, appointment staff, consider bids for funding and promote the project. The Chairman is re-elected every three years and is responsible for recruiting members with appropriate skills and expertise. Our previous annual reports provide more information about the project background and aims. These can be found on our website ( or by contacting a member of the audit team (section 8). 3.2 Aims and objectives of the project To support clinical governance in vascular surgery To maintain a database on vascular surgery outcomes for North West England To collaborate with the Vascular Society of Great Britain and Ireland to develop quality standards

6 5 To work with the Vascular Society of Great Britain and Ireland to develop risk stratification schemes To improve vascular care in the region through re-audit to these standards To agree management guidelines for vascular diseases To design and implement relevant procedure specific audits. Audit topics already underway are: a) Carotid endarterectomy (CEA from February 2) b) Open abdominal aortic aneurysm repair (from August 2) c) Endovascular AAA repair (from May 26) d) Infra-inguinal bypass( IIB from 22 to March 26) e) Amputation practice and rehabilitation(from May 26) f) Smoking Cessation Audit (from May 26)

7 6 4 Clinical Governance 4.1 Advisory Committee There have been no new appointments to the Advisory Committee. 4.2 Changes to the structure of the Steering Committee Professor McCollum resigned as Chairman at the end of 26 after being in office for three years. Vince Smyth (Manchester Royal Infirmary) has been elected as the new Chairman following a postal vote by the membership. Professor McCollum has taken the role of secretary. Mr Oshodi (Pennine Acute Trust) has recently joined the committee to give a fuller representation of the region. 4.3 North West vascular standards For the audit process to inform the Advisory Committee on performance related concerns, there must be a clear and reproducible mechanism by which performance is compared to an accepted standard. Therefore a set of procedure specific vascular standards have been formulated: Carotid endarterectomy (CEA): Peri-operative stroke. Peri-operative mortality. Carotid artery stenosis as an indication for surgery. Return to theatre. Sufficient workload to maintain expertise. Elective abdominal aortic aneurysm (AAA) repair: Peri-operative mortality. Major amputation. Aneurysm diameter as an indication for surgery. Intra-operative blood transfusion volumes. Return to theatre. Sufficient workload to maintain expertise. The standards were identified initially through analysis of the existing data and consultation with the Steering Group. The draft set was presented to the Mersey and Greater Manchester regions in October 22, and general agreement was reached. Each surgeon receives an individual report against these standards. Further discussion and ratification followed at presentations to the Mersey Vascular Meeting in March 23, and to the M6 Group Meeting (Greater Manchester vascular surgeons) in June 23. The standards are detailed in Appendix Appraisal and revalidation We produce summary figures and individual reports for surgeons when they undergo their annual appraisal. We aim to introduce a new system of evaluating a surgeon s performance by producing funnel plots, which will be anonymised and sent to individual surgeons with the annual report.

8 7 5 Improving Data Quality 5.1 Data validation All contributing parties in the North West vascular audit database have invested a considerable effort. In return, each surgeon expects to be supported by a reliable evidence base that can be used to improve his or her services. The main data validity issues being addressed by the North West Vascular Audit are: A complete database of all eligible cases As well as having access to individual units HES data, we also have access to the North West Tactical Information Service, and are now in a position to produce accurate reports detailing the number of procedures performed by surgeons during given periods. A complete dataset on each case A missing data report will now be sent to each surgeon on a regular basis, with a summary of his or her own data and a comparison to the vascular standards. The report will detail all the important missing fields, which will include fields identified by statistical analysis to give a minimum dataset. 5.2 Risk scoring League tables presented by groups such as Dr Foster are misleading, as crude mortality rates do not take into account pre-surgical morbidity or the case mix referred to each surgeon. It is essential that our audit adequately reflects the difficulty and complexity of surgery undertaken by each participating vascular unit. We no longer intend to use POSSUM 1 methods for risk scoring and have updated our data entry form to focus less on POSSUM fields and to highlight data that relates statistically to the main outcomes. The National Vascular Database is also moving away from POSSUM scoring methods (including P_POSSUM and V_POSSUM) in predicting vascular surgery outcomes. Alternative procedure-specific databases of factors statistically related to outcomes are being developed in close collaboration with the Dept. of Medical Statistics (Julie Morris / Bernice Dillon). Three different approaches are being considered to combine the significant fields into a risk-scoring model: a multivariate logistic regression model, a Bayes table model and a neural network model. The development of the risk-scoring models should enable less complex data collection forms which will be easier for participating surgeons to complete. 1 Wijesinghe, LD et al. Comparison of POSSUM and the Portsmouth predictor equation for predicting death following vascular surgery. Br J Surg 1998; 85: 29-12

9 8 6 Ongoing Issues 6.1 Work during the reporting period The period has been a busy period for VGNW; the audit team have seen several changes in staffing. Michael Cox has moved on to Co-ordinate an audit into spinal cord compression, Debasree has gone on maternity leave, and had her baby. The audit officer is now Karen Kane, and Sean Garbett is the temporary co-ordinator. The funding bid submitted last year was successful, however our budget was cut by over 3%. Fortunately, after months of discussion, we have now managed to get this re-instated. Funding is an issue that needs to be continually addressed. We have shortened our data collection forms, and have worked alongside the NVD to achieve this; we are also in the process of introducing a new web based tool, which we hope will go live soon. We are also able to report that outcomes have improved since VGNW started (see 21 & 29). 6.2 Website The website continues to be a valuable resource for all interested parties, and includes a members section where participating surgeons can access confidential reports and view committee documents. The data capture forms and copies of our electronic databases are also available online. The website will be updated in line with the new data collection forms Vascular Society links The year s data has been successfully uploaded to the NVD, who were extremely pleased with it, however the UKCEA have experienced difficulties in importing our data. The NVD comment: At a time when surgeons are under constant scrutiny a National audit over which they have control and input provides a protective shield for both the surgeon and the patient, as well as a riposte to the criticism sometimes implied by statistics reported in the media. The North West Vascular Group is unique in that it provides vascular audit data for a geographical group representing a diverse range of vascular units from teaching hospital and tertiary referral centres to District General hospitals each of which has a role in the provision of vascular services. The team managing this process are working ever more closely with the Vascular Society of Great Britain & Ireland [ VSGBI] and their National Vascular Database to ensure a seamless continuity with the national datasets and the national agenda for vascular surgery and treatments. This collaboration is to the benefit of both groups, recently allowing an objective dialogue regarding two of the most topical current issues; hospital infection in relation to graft infection; and scrutiny of endovascular therapies, which may well form a future national audit.

10 9 7 Audits 7.1 General methodology The focus of the North West Vascular Audit is a long-term data collection process to monitor and report on regional standards for the following vascular procedures or related topics: Carotid endarterectomy (CEA) Abdominal aortic aneurysm (AAA) repair Endovascular Aneurysm Repair (EVAR) Major limb amputation Smoking Cessation Sample and dates The CEA audit began in February 2 and includes all patients undergoing carotid endarterectomy. The AAA repair audit began in August 2 and has focused primarily on elective open AAA repair, subsequently expanding to include emergency cases. Data on EVAR s is now also being collected Data collection and transfer For each audit there is a data collection form that has been purpose-designed to cover patient demographics, pre-operative risk factors, intra-operative findings, post-operative outcomes to 3 days and where relevant long term outcome. There is also a corresponding Microsoft Access database available for each. Participating surgeons decide on whether data is collected prospectively or retrospectively, on paper or computer, separately or as a team; the audit team assists where possible. Data in whatever form is sent to the audit team at South Manchester University Hospital, and input to the central Microsoft Access database, anonymised by removing any patient identifying data. For transfer to the national database, data is exported to a Microsoft Excel spreadsheet, and sent via NHSnet to the VSBGI, using agreed codes to remove the identity of individual units and surgeons. Copies of the data collection forms and blank databases are available on the website:

11 1 Patient recruitment to VGNW. 26 data returns by month CEA AAA 4 2 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 27 data returns by month CEA AAA AMP 2 jan feb mar apr may jun jul aug sep oct nov dec Communication of results Participating surgeons are provided with data summaries of their own results, compared to results for all surgeons across the NW region. There are currently three CEA and three AAA reports. We aim to standardise the production of these to six monthly intervals to encourage more regular data submission. We have decided to introduce anonymised funnel plots to monitor each surgeons performance with respect to the set standards and send out one such report to each surgeon along with the annual report.

12 11 A summary of the year s progress is also presented at the Annual Meeting for all North West Vascular Surgeons held each October, and at various ad hoc presentations throughout the year. Participating surgeons are encouraged to use the North West data for local audit projects and can request bespoke anonymised reports to provide them with accurate peer comparisons. They may also request access to the database for research purposes.

13 Carotid Endarterectomy Patient sample There were 395 records on the database by end of June 27. Each CEA, including re-operations or contralateral operations are treated as separate episodes, if more than 3 days apart Gender 35% Male Female 65% Age of patients n % Mean (yrs) Range Male Female

14 13 Gender and Age groups % Male Female < Mode of admission 1% 3% 2% Elective Unplanned Emergency Transfer* 94% * Will also be included in one of the other groups

15 14 Indications for surgery 5 % Some patients experience more than one symptom Amaurosis Fugax TIA Previous Stroke Other Asymptomatic Male Female Grade of stenosis % Ipsilateral Contralateral < (occluded)

16 15 Pre-operative heart disease 46% Yes No 54% n Total % MI > 6/12 ago MI < 6/12 ago 96 6 HF > 1/12 ago 59 4 HF < 1/12 ago 13 1 Orthopnea 31 2 Angina on exertion Angina at rest 39 2 Outcomes vs. cardiac Hx Dead Post op CVA 2 MI > 6/12 ago MI < 6/12 ago HF > 1/12 ago HF < 1/12 ago Orthopnea Angina on exertion Angina at rest

17 16 Grade of senior surgeon and outcomes Consultant Staff grade/associate SpR % Total CVA Dead Grade of senior anaesthetist and outcomes Consultant Staff grade/associate SpR % Total CVA Dead

18 17 Type of anaesthetic Block/local General Type of procedure Standard 1 Graft replacment 4 3 Eversion Redo Other

19 18 Use of a patch 1% Vein Prosthetic % Yes No Changes in rankin score pre op vs. post op 27% 3% no change worse off better off 7%

20 19 Mortality rate for patients who return to theatre within 3 days % Returned 1 No return Post op stroke rate for patients who return to theatre within 3 days % Returned 2 No return

21 2 Gender and Return to theatre rate 4% Male Female 6% Comparison to VGNW standards Rates - Compairson to VGNW standards 12 1 % standard Rate CVA Death RTT

22 21 Improving Clinical Standards Carotid Endarterectomy Our data shows reduced stroke and death after carotid surgery and reduced mortality after aneurysm repair since Vascular Governance North West started Stroke by year % Stroke and death by year

23 Abdominal Aortic Aneurysm Patient sample There were 237 records on the database by the end of June. Each repair, including re-operations are treated as separate episodes, if more than 3 days apart Unless otherwise stated, the data in this report is based upon elective, open repairs only Mode of Admission % Elective 12.4% 75.4% Unplanned Emergency Not recorded OpenRepair by Gender % Elective Urgent Emergency Male Female

24 23 Age and gender n % Mean (yrs) Range Male Female Cardiac History % 3 2 Yes No 1 Elective Urgent Emergency

25 24 Symptomatic 3% Yes No 7% Imaging modalities Open (2173 cases) No Chest Abdo US Plain CT Spiral CT Other Imaging Modality

26 25 Previous surgery/stent 1% Yes No 99% Renal function of those with previous surgery/stent Change in renal function % Yes 5 29 No % Yes No 71%

27 26 Aneurysm diameter no < >9.9 diameter (cms) Transfusion type vs mortality % Alive Dead Haemodilution Cell salvage Red cells FFP Platelets None Transfusion Grade of operating surgeon/anaethetist Surgeon Anaethetist consultant staff grade 47 2 SpR null

28 27 Complications following surgery Open (elective) n=1526 Open (Urgent/emergency) n=57 % Infection Limb ischaemia Graft complications Wound haemorrhage Wound dehiscence Venous thrombosis Stroke MI CF Impaired renal function Hypotension Respiratory Failure Ischaemic bowel Infection post-operatively % Open (elective) n=1526 Open (Urgent/emergency) n= Chest Wound UTI Intra-abdominal Septicemia Graft PUO

29 28 Length of stay in hospital Open elective n=1261 Open urgent/emergency (n=174) EVAR all (n=111) % >6 weeks Thirty day mortality Admission type Total 3 day mortality Mortality rate Alive Dead Null data Open Elective % 97/1398 Open Urgent % 21/174 Open Emergency % 138/349 EVAR All % 5/16 Total 2224 Missing

30 29 Improving Clinical Standards Aneurysm Repair Our data shows reduced mortality after aneurysm repair since Vascular Governance North West started. 12 Mortality by year - Elective 1 8 % Mortality by year - Urgent and Emergency %

31 3 7.4 Amputation Audit An audit tool for the collection of data regarding amputation has been developed in collaboration with Dr Van Ross, Audit Lead, North West Amputee Audit and the Vascular Society of Great Britain and Ireland. Outcomes include wound healing and final mobility achieved by the patient and relates these to pre-operation and surgical factors. The proportion of amputees who are not referred to the limb fitting service will also be identified. There is insufficient data for statistical analysis. 7.5 Peripheral Bypass Register To determine outcomes following major limb amputations in the region, the Steering Group has set up of a registry of surgical and radiological below groin procedures. Registers are submitted monthly. Since January registers have been submitted by 23 surgeons. This represents 14 hospitals. 112 individual cases have been recorded on the database. 7.6 Smoking Cessation Audit Patients 197 questionnaires have been returned by patients who do not smoke. 13 questionnaires have been returned by smokers. 32 follow up questionnaires have been received 4 follow-up questionnaires are due to be sent out over July and August. The questionnaires have been returned from only 6 hospitals. Consultants 35 consultants have returned the questionnaire. This takes account of 18 hospitals. A full report will be made later in the year when follow-up data has been received.

32 31 8 Contact For further information regarding any aspect of this project, please contact Sean Garbett/Karen Kane at: Clinical Audit Department First Floor ERC University Hospital of South Manchester Southmoor Road Wythenshawe M23 9LT Tel: Fax: sean.garbett@smtr.nhs.uk/karen.kane@smtr.nhs.uk Website: 9 List of Appendices Appendix 1 Contributing surgeons Appendix 2 North West Vascular Standards Appendix 3 Committee membership

33 32 Appendix 1 Contributing surgeons - data submitted - not contributing? not started submitting yet Name Hospital CEA AAA Mr Stephen Blair Arrowe Park Hospital Mr Martin Greaney Arrowe Park Hospital Mr David Reilly Arrowe Park Hospital Mr R Chandrasekar Arrowe Park Hospital Mr D Chan Arrowe Park Hospital?? Mr Simon Hardy Blackburn Royal Infirmary Mr Robert Salaman Blackburn Royal Infirmary Mr Leslie Forrest (retired) Blackpool Victoria Hospital Mr Mark Lambert (left) Blackpool Victoria Hospital Mr Hisham Osman Blackpool Victoria Hospital Mr Graham Riding (left) Blackpool Victoria Hospital Mr Haytham Al-Khaffaf Burnley General Hospital Mr M A Rahi Burnley General Hospital Mrs Linda de Cossart Countess of Chester Mr Paul Edwards Countess of Chester Mr Sameh Dimitri Countess of Chester Mr Otto Klimach Glan Clwyd Hospital Mr Rouhani Glan Clwyd Hospital?? Mr John Mosley Leigh Infirmary Mr Mohideen Jameel Royal Albert Edward Infirmary?? Mr Andrew Guy (inactive) Leighton Hospital Mr Magdi Hanafy Leighton Hospital Mr Duncan Matheson (inactive) Macclesfield General Hospital Mr JV Smyth Manchester Royal Infirmary Mr Irwin Mohan(left) Manchester Royal Infirmary Mr Gerard Williams North Manchester General Hospital Mr Graeme Ferguson Royal Bolton Hospital Mr Madu Onwudike Royal Bolton Hospital Mr John Abraham Royal Lancaster Infirmary Mr Stuart Walker (left region) Royal Lancaster Infirmary Mr Paul Wilson Royal Lancaster Infirmary Mr John Calvey Royal Lancaster Infirmary Mr M Bukhari Royal Lancaster Infirmary Mr M Tomlinson Royal Lancaster Infirmary Mr John Brennan Royal Liverpool University Hospital Mr S Rao Royal Liverpool University Hospital Mr Neil Hulton Royal Oldham Hospital Mr Taohid Oshodi Royal Oldham Hospital Mr Matthew Hadfield Royal Oldham Hospital Mr George Thomson Royal Preston Hospital Mr Robert Hughes (retired) Royal Preston Hospital

34 Professor Charlesworth (retired) South Manchester University Hospital Professor Charles McCollum South Manchester University Hospital Mr Akhtar Nasim (left) South Manchester University Hospital Mr Mark Welch South Manchester University Hospital Mr M Baguneid South Manchester University Hospital Mr David Jones Southport District General Hospital Mr Frank Mason Southport District General Hospital Mr Anthony Woodyer Tameside District General Hospital Mr Pratap Tameside District General Hospital?? Mr J Joseph University Hospital Aintree Mr Francesco Torella University Hospital Aintree Mr A da Silva Wrexham Maelor Hospital Mr Mark Scriven Wrexham Maelor Hospital Miss U Kirkpatrick Wrexham Maelor Hospital?? Mr Paul Moody Warrington General Hospital?? Mr Tom Nicholas Warrington General Hospital?? 33

35 34 Appendix 2 North West Vascular Standards Carotid Endarterectomy 1 Peri-operative stroke rate Less than 3 strokes in 3 cases. Less than 4 strokes in 5 cases. Less than 5 strokes in 7 cases. Less than 6 strokes in 1 cases. Less than 8 strokes in 15 cases. Less than 1 strokes in 2 cases. Thereafter a stroke rate of < 5% 2 Internal carotid artery stenosis > 5%. Elective AAA repair 1 Major amputation rate Less than 3 amputations in 3 cases. Less than 4 amputations in 5 cases. Less than 5 amputations in 7 cases. Less than 6 amputations in 1 cases. Thereafter an amputation rate of < 5% 2 Asymptomatic aneurysm > 5cm diameter. 3 Peri-operative death rate Less than 2 deaths in 3 cases. Less than 3 deaths in 6 cases. Less than 4 deaths in 1 cases. Less than 5 deaths in 15 cases. Less than 6 deaths in 2 cases Less than 8 deaths in 3 cases Thereafter a death rate of < 2.5% 4 Return to theatre within 3 days Less than 4 re-operations in 3 cases. Less than 5 re-operations in 5 cases. Less than 6 re-operations in 7 cases. Less than 7 re-operations in 1 cases. Thereafter a re-operation rate of < 7% 5 More than 5 CEAs performed per year, except during the first two years of consultant practice. 3 Peri-operative homologous blood transfusion >4 units in less than 25% patients. 4 Peri-operative death rate Less than 3 deaths in 2 cases. Less than 4 deaths in 3 cases. Less than 5 deaths in 5 cases. Thereafter a death rate of < 1% 5 Return to theatre within 3 days Less than 3 re-operations in 2 cases. Less than 4 re-operations in 3 cases. Less than 5 re-operations in 5 cases. Thereafter a re-operation rate of <1% 6 More than 5 AAA repairs performed per year, except during the first two years of consultant practice.

36 35 Appendix 3 Committee membership Steering Committee J V Smyth Consultant Surgeon (Central Manchester Healthcare NHS Trust) Chair Charles M c Collum Consultant Surgeon (South Manchester University Hospitals) Secretary Martin Greaney Consultant Surgeon (Wirral Hospital NHS Trust) Advisory Committee Link John Brennan Consultant Surgeon (Royal Liverpool and Broadgreen University Hospitals NHS Trust) Graeme Ferguson Consultant Surgeon (Bolton Hospitals NHS Trust) Dele Oshodi Consultant Surgeon (Pennine Acute Trust) Sean Garbett Audit Co-ordnator (South Manchester University Hospitals NHS Trust) Karen Kane Audit Officer (South Manchester University Hospitals NHS Trust) Advisory Committee Martin Greaney Consultant Surgeon (Wirral Hospital NHS Trust ) Simon Hardy Consultant Surgeon (Blackburn Hyndburn and Ribble Valley Healthcare NHS Trust) Moataseim Bukhari Consultant Surgeon (Morecambe Bay Hospitals NHS Trust )

37 36 Supplement to Annual Report Anonymised unit comparison to NW standards - elective abdominal aortic aneurysm repair Hospital Total submitted Standard met? Death Amputation Small aneurysm Blood transfusion Return to theatre Count>5 Mortality rate Standard met? Amputation rate Standard met? Count Standard met? %>4 units Standard met? Re-op rate Standard met? No of standards not met Hospital A 42 No %(7/41) Yes (1/41) Yes No 48% Yes 5.%(2/41) No 3 Hospital B 67 Yes 5.9%(4/67) Yes - No 5 3 Yes 4% Yes 8.9%(6/67) Yes 1 Hospital C 17 No %(4/17) Yes - Yes No 31% No 17.6%(3/17) No 4 Hospital D 11 Yes 5.5%(6/19) Yes No 6 4 Yes 22% Yes 3.7%(4/18) Yes 1 Hospital E 38 Yes 5.3%(2/38) Yes - No 7 1 No 38% Yes 1.5%(4/38) No 4 Hospital F 36 No %(6/36) Yes - Yes Yes 16% Yes 5.7%(2/35) Yes 1 Hospital G 1 Yes Yes - Yes Yes % Yes No 1 Hospital H 65 Yes 3.4%(2/58) Yes - Yes Yes 2% No 17.2%(1/58) No 2 Hospital J 89 Yes 5.6%(5/89) Yes - Yes Yes 22% No 1.1%(9/89) No 2 Hospital K 81 No 4 1.1%(8/79) Yes - No 8 2 Yes 18% Yes 6.51%(5/81) No 3 Hospital M 117 Yes 7.6%(8/15) Yes (1/76) No 9 1 No 26% Yes 7%(7/1) No 3 Hospital N 99 Yes 2.1%(2/91) Yes Yes Yes 6% Yes 11.7%(2/17) No 1 Hospital O 18 Yes 5.5%(6/18) Yes - Yes Yes 1% Yes 3.7%(4/16) Yes Hospital P 17 Yes Yes - Yes Yes 8% Yes 5.9%(1/17) Yes Hospital Q 2 Yes Yes - Yes Yes % Yes Yes Hospital R 11 Yes 7%(7/99) Yes - No 1 1 Yes 21% Yes 8%(8/1) Yes 1 Hospital S 18 Yes Yes - Yes No 3% Yes 12.5%(2/16) Yes 1 Hospital T 64 Yes Yes - No 11 1 Yes 22% Yes 7.5%(4/53) No 2 Hospital U 375 Yes 5.4%(2/369) Yes - No 12 3 Yes 8% Yes 6.8%(25/364) Yes 1 Hospital V 115 Yes 8.9%(1/112) Yes - Yes Yes 22% Yes 9.1%(1/19) Yes Hospital W 31 Yes 6.4%(2/31) Yes - Yes No 27% No 2.6%(6/29) No 3 Hospital X 127 Yes 6.4%(2/31) Yes - No 13 3 Yes % Yes 4.9%(6/122) No Vascular Governance North West. Annual Report 26/27 36

38 x haemhorrhage, 1 x heart failure, 1 x respiratory failure, 1 x multi-organ failure, 1 x not recorded ; 2. 2 x bleeding, 1 x multi-organ failure, 1 x respiratory arrest;3. 1 x sepsis, 2 x MI, 2 x multi-organ failure; 4. 1 x pneumonia, 1 x DIC, 1 x sepsis, 1x MI, 1 x multiorgan failure, 1x respiratory failure, 2x no details 5.1 x large iliac aneurysm 2x no details; , 13. no details; x no details, 1 x pulmonary oedema ; Some units still have problems of data collection which explains the failure to meet the standards on count Vascular Governance North West. Annual Report 26/27 37

39 38 2.Anonymised unit comparison to NW standards - carotid endarterectomy Hospital Total submitted Standard met? Stroke Death Stenosis Return to theatre Count Stroke rate Standard met? Mortality rate Standard met? Count Standard met? Re-op rate Standard met? No of standards not met Hospital A 5 Yes 6%(3/5) Yes 4.1%(2/5) Yes Yes 4%(2/5) No 1 Hospital B 114 Yes 1.9%(2/13) Yes 1.8%(2/112) No 1 Yes 4.4%(5/113) Yes 1 Hospital C 3 Yes Yes Yes Yes No 1 Hospital D 17 Yes 4.3%(5/1154) Yes.6%(1/167) Yes Yes 4.9%(8/163) Yes Hospital E 194 Yes 1.6%(3/19) Yes.6%(1/18) No 1 Yes 2.1%(4/193) Yes 1 Hospital F 4 Yes 2.6%(1/39) Yes 5%(2/4) Yes Yes 11.1%(4/36) Yes Hospital G Hospital H 144 Yes 5.1%(7/136) Yes 2.9%(4/138) Yes Yes 3.8%(5/132) Yes Hospital J 169 Yes 1.8%(3/164) Yes 1.5%(2/136) Yes Yes.6%(1/163) Yes Hospital K 149 Yes 2.8%(4/145) Yes.7%(1/137) Yes Yes 2.1%(3/144) Yes Hospital M 297 Yes 3.4%(9/263) Yes 2.1%(6/29) Yes Yes 4.5%(1/222) Yes Hospital N 247 Yes 2.4%(6/246) Yes 1.2%(3/243) Yes Yes 3.9%(7/178) Yes Hospital O 13 Yes Yes Yes Yes 2%(2/12) Yes Hospital P 95 Yes 2.1%(2/93) Yes No 2 Yes 5.4%(5/92) No 2 Hospital Q 7 Yes Yes 14.3%(1/7) Yes Yes 14.2%(1/7) Yes Hospital R 122 Yes Yes 1.7%(1/121) Yes Yes.8%(1/122) Yes Hospital S 62 Yes 4.9%(2/41) Yes 2.6%(1/38) Yes Yes 4.2%(2/48) Yes Hospital T 94 Yes 5.8%(4/69) Yes Yes No 12.3%(1/81) Yes 1 Hospital U 79 Yes 1.8%(12/641) Yes.9%(6/688) No 1 Yes 3.7%(25/667) Yes 1 Hospital V 72 Yes 5.6%(4/71) Yes No 1 Yes 2.8%(1/71) Yes 1 Hospital W 26 Yes Yes 3.8%(1/26) Yes Yes 3.8%(1/26) No 1 Hospital X 28 Yes 2.9%(6/28) Yes 2.4%(5/28) Yes Yes 5.9%(12/22) No *(5 records were non-nhs) Vascular Governance North West. Annual Report 26/27 38