Volume 35, Issue 2 , Pages 129-130, February 2008
Twenty Years with the Swedvasc Registry☆
Article Outline
The Swedvasc Registry started in January 1987. We thought it appropriate to commemorate the 20th Anniversary by performing a series of investigations based on the Registry, which by November 2007 contained information on 158.000 open and endovascular procedures. At the tenth Anniversary a series of articles were published as a supplement to the European Journal of Surgery.1 This time we decided to publish independent original articles to benefit from the peer review and to reach a greater readership. We have agreed to submit the papers to the EJVES, the first paper being published in this edition reporting on vascular injuries.
All patients at risk being nested prospectively in the Registry cohort, and the great number of observations, represent major methodological advantages, when analyzing risk-factors for events in a case-control design. This enabled us to analyze uncommon procedures such as operations for acute occlusion of the superior mesenteric artery2 or popliteal artery aneurysms,3 as well as uncommon events such as colonic ischaemia after aortoiliac surgery4 or stroke after carotid TEA.5 Two papers in this series will study less common procedures such as interventions for upper extremity ischaemia and renovascular disease.
A major limitation of registry-data is the validation. We have invested a large amount of work in validating the Registry, and we are aware of the problems. The Swedish system with a unique personal identity code makes it possible to cross-match data in different registries on an individual level. It is possible to identify patients who were operated on and registered in the In-Patient Registry, but not registered in the Swedvasc, and then study their survival by cross-matching with the Population Registry. We were given permission by the Health Authorities to perform this validation regarding mortality after surgery for AAA, and those data will be published.
The most common open surgical procedures, representing core surgery, are being registered with great validity. This, however, may not be true for endovascular procedures, due to incomplete registration, with the exception of EVAR. The original variables established in 1987 did not reflect the complexity of modern endovascular procedures. In close collaboration with the Seldinger Society for Vascular and Interventional Radiology a new release of the Registry is launched, where these problems have been dealt with. Another potential problem is the fact that the same patient often undergoes several operations, at the same or different anatomical locations. The issue of redo-procedures is in fact quite complex and has created problems.6 In the new release we have focused our efforts on primary procedures for aortic aneurysm, carotid artery stenosis and lower extremity occlusive disease. The less frequent primary and the redo procedures will still be registered, but in lesser detail. In addition to the basic and mandatory data, it will be possible to register data on temporary projects with specific aims.
One of the aims of the Swedvasc was to serve as an instrument for quality improvement. The hospital-specific outcomes of twelve quality indicators have been followed since year 2000. The outcomes of those indicators are published openly since 2003, which has facilitated the quality improvement process.
The large database also makes it possible to describe the development of vascular surgery over time: The introduction of new technology, changes in indications for surgery, regional differences, the importance of surgeon's and hospital's volumes for outcome. Outcome after AAA-repair for the time period 1994–2005 has already been described7: The introduction of EVAR resulted in an increased incidence of repair of intact but not of ruptured AAA. In both groups the peri-operative mortality decreased over time, despite the fact that older patients were treated. Thought-provoking time-trends on surgery for carotid artery stenosis, as well as lower extremity acute and chronic ischaemia, will be presented in articles to be submitted to this Journal.
One of the great advantages of registry data in the age of the Internet is the rapid feed-back of data. This is of particular interest in a speciality with rapidly evolving new technology. The annual report of the Swedvasc is published already in April, including 30-day outcome data from last December. The Registry is updated every week with data from the Population Registry, so that survival data are at most three weeks old. Open information on outcomes after surgery is being requested by both public and decision-makers ever more often. Rather than becoming the victims, we believe we can master the situation ourselves. Surgeons who don't count, don't count.
References
- Auditing Surgical outcome. Ten years with The Swedish Vascular Registry-Swedvasc. Eur J Surg. 1998;164(Suppl. 581):1–48
- . Revascularisation of the superior mesenteric artery after acute thromboembolic occlusion. Br J Surg. 2002;89:923–927
- . Popliteal artery aneurysm with acute ischemia in 229 patients. Outcome after thrombolytic and surgical therapy. Eur J Vasc Endovasc Surg. 2007;33:690–695
- . Incidence and clinical presentation of bowel ischaemia after aortoiliac surgery – 2930 operations from a population-based registry in Sweden. Eur J Vasc Endovasc Surg. 1996;12:139–149
- . Outcomes of carotid endarterectomy for asymptomatic stenosis in Sweden are improving–results from a population based registry. J Vasc Surg. 2006;44:79–85
- Reoperations, redo surgery and other site interventions constitute more than one third of vascular surgery. A study from Swedvasc – the Swedish Vascular Registry. Eur J Vasc Endovasc Surg. 1997;14:244–251
- Wanhainen A, Bylund N, Björck M. Abdominal aortic aneurysm repair in Sweden. Improved outcome over time 1994–2005. Br J Surg, in Press.
☆ The authors are members of the Steering Committee of the Swedvasc.
PII: S1078-5884(07)00722-8
doi:10.1016/j.ejvs.2007.11.007
© 2007 European Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
Refers to article:
- Iatrogenic Vascular Injuries in Sweden. A Nationwide Study 1987–2005 , 09 November 2007
Volume 35, Issue 2 , Pages 129-130, February 2008
