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Tools for endovascular performance assessment are necessary in competency based education. This study aimed to develop and test a detailed analysis tool to assess steps, errors, and events in peripheral endovascular interventions (PVI). A modified Delphi consensus was used to identify steps, errors, and events in iliac–femoral–popliteal endovascular interventions. International experts in vascular surgery, interventional radiology, cardiology, and angiology were identified, based on their scientific track record. In an initial open ended survey round, experts volunteered a comprehensive list of steps, errors, and events. The items were then rated on a five point Likert scale until consensus was reached with a pre-defined threshold (Cronbach's alpha > 0.7) and > 70% expert agreement. An experienced endovascular surgeon applied the finalised frameworks on 10 previously videorecorded elective PVI cases. The expert consensus panel was formed by 28 of 98 invited proceduralists, consisting of three angiologists, seven interventional radiologists, five cardiologists, and 13 vascular surgeons, with 29% from North America and 71% from Europe. The Delphi process was completed after three rounds (Cronbach's alpha; α steps = 0.79; α errors = 0.90; α events = 0.90), with 15, 26, and 18 items included in the final step (73 – 100% agreement), error (73 – 100% agreement), and event (73 – 100% agreement) frameworks, respectively. The median rating time per case was 4.3 hours (interquartile range [IQR] 3.2, 5 hours). A median of 55 steps (IQR 40, 67), 27 errors (IQR 21, 49), and two events (IQR 1, 6) were identified per case. An evaluation tool for the procedural steps, errors, and events in iliac–femoral–popliteal endovascular procedures was developed through a modified Delphi consensus and applied to recorded intra-operative data to identify hazardous steps, common errors, and events. Procedural mastery may be promoted by using the frameworks to provide endovascular proceduralists with detailed technical performance feedback. [ABSTRACT FROM AUTHOR]

Introduction: Lower extremity amputation (LEA) is a life altering procedure, with significant negative impacts to patients, care partners, and the overall health system. There are gaps in knowledge with respect to patterns of healthcare utilization following LEA due to dysvascular etiology. Objective: To examine inpatient acute and emergency department (ED) healthcare utilization among an incident cohort of individuals with major dysvascular LEA 1 year post-initial amputation; and to identify factors associated with acute care readmissions and ED visits. Design: Retrospective cohort study using population-level administrative data. Setting: Ontario, Canada. Population: Adults individuals (18 years or older) with a major dysvascular LEA between April 1, 2004 and March 31, 2018. Interventions: Not applicable. Main outcome measures: Acute care hospitalizations and ED visits within one year post-initial discharge. Results: A total of 10,905 individuals with major dysvascular LEA were identified (67.7% male). There were 14,363 acute hospitalizations and 19,660 ED visits within one year post-discharge from initial amputation acute stay. The highest common risk factors across all the models included age of 65 years or older (versus less than 65 years), high comorbidity (versus low), and low and moderate continuity of care (versus high). Sex differences were identified for risk factors for hospitalizations, with differences in the types of comorbidities increasing risk and geographical setting. Conclusion: Persons with LEA were generally more at risk for acute hospitalizations and ED visits if higher comorbidity and lower continuity of care. Clinical care efforts might focus on improving transitions from the acute setting such as coordinated and integrated care for sub-populations with LEA who are more at risk. [ABSTRACT FROM AUTHOR]

Background: Patients who undergo vascular surgery are burdened by high early readmission rates. We examined the frequency and cause of early readmissions after elective and emergent admission to the vascular surgery service at our institution to identify modifiable targets for quality improvement. Methods: Over a 5-year period, all patients admitted and readmitted to the vascular surgery service were identified. Medical records were then individually reviewed to identify baseline characteristics from the index admission and the most responsible diagnosis for readmission within 28 days of discharge. Results: Of a total of 3324 patients, 421 (12.7%) were readmitted to our institution within 28 days of discharge. Forty-seven were found to have more than 1 readmission following their index admission. The readmission rate ranged from 11.8% to 14.1% over the 5-year study period, resulting in an average readmission rate of 12.7%. There were similar rates for men (12.9%) and women (12.3%). Of the readmitted cases, 236 (63.1%) were unplanned readmissions. The most common diagnoses for unplanned readmissions were worsening of peripheral arterial disease status including complications related to peripheral bypass graft (30.9%), surgical site infections (15.3%) and nonsurgical infections (14.8%). Conclusion: To reduce readmission rates effectively, institutions must identify high-risk patients. In our study cohort, the most frequent pathology resulting in readmission was peripheral arterial disease. The most frequent preventable reason for readmission was surgical site infection. Interventions focused on early assessment of clinical status and wounds in addition to avoidance of infectious complications could help reduce readmission rates. Preventive resources can be efficiently targeted by focusing on subgroups at risk for readmission. Contexte: Les patients soumis a une chirurgie vasculaire presentent malheureusement un taux eleve de readmission precoce. Nous avons analyse la frequence et les causes de readmission precoce apres une admission urgente ou non urgente au service de chirurgie vasculaire afin d'identifier les facteurs modifiables en vue d'ameliorer la qualite des soins. Methodes: Sur une periode de 5 ans, tous les patients admis, puis readmis au service de chirurgie vasculaire ont ete identifies. On a ensuite passe en revue individuellement les dossiers medicaux pour relever les caracteristiques de base a l'admission initiale et le diagnostic ayant le plus probablement justifie la readmission dans les 28 jours suivant le conge. Resultats: Sur un total de 3324 patients, 421 (12,7%) ont ete readmis a notre etablissement dans les 28 jours suivant leur conge. Quarante-sept ont ete readmis plus d'une fois apres leur hospitalisation initiale. Le taux de readmission a varie de 11,8% a 14,1% pendant la periode de 5 ans de l'etude, le taux moyen de readmission etant de 12,7%. Les taux etaient similaires chez les hommes (12,9%) et les femmes (12,3%). Parmi les cas readmis, 236 (63,1%) etaient imprevus. Les diagnostics ayant le plus souvent justifie une readmission imprevue etaient aggravation de la maladie arterielle peripherique (y compris complications au niveau de pontages arteriels peripheriques) (30,9%), infection du site operatoire (15,3%) et infections non chirurgicales (14,8%). Conclusion: Pour reduire efficacement les taux de readmission, les etablissements doivent identifier les patients a haut risque. Dans notre cohorte, la pathologie ayant le plus souvent mene a une readmission etait la maladie arterielle peripherique. La raison evitable la plus frequente etait l'infection du site operatoire. Les interventions axees sur une evaluation rapide de l'etat clinique et de l'etat des plaies, ainsi que la prevention des complications infectieuses pourraient contribuer a reduire les taux de readmission. Des mesures preventives pourraient cibler judicieusement les groupes a risque de readmission., Hospital readmission has become a focus of quality improvement initiatives because of the associated burden on patients and the health care system. Many studies have found that unplanned readmissions are [...]