- Email: [email protected]
Preliminary experience with a large scale vascular registry
COMMITI-EE REPORT
Preliminary Experience With a Large Scale Vascular Registry
Allastair M. Karmody, MD, Albany, New York Robert M. Blumenberg, MD, Schenectady,
New York
C. Allen Wall, MD, San Francisco, California
One of the most attractive features of the discipline of vascular surgery is the clear delineation of an end-point. This makes recording easier because success renders a patient symptom-free, signs of benefit are easy to determine, and physical measurements can be made with considerable validity. The bases of published reports on vascular surgery have been the experience, results, and wisdom of individuals, small groups, or well-circumscribed institutions. When multiinstitutional surveys have been collected, analyzed, and published, an area of special interest is generally the focal point. In an effort to obtain a broader, current, and more realistic data base, the Society for Clinical Vascular Surgery, an organization of 471 clinically active surgeons for whom vascular surgery is a major component of their clinical practice, initiated a study into the practical aspects of establishing a vascular registry. An initial 3 month pilot study by a small group in 1981 was carried out to define parameters. A larger study encompassing the 9 month period from April 1,1982 through December 31,1982 was undertaken on a voluntary basis by the membership to assess the practical aspects of collecting, tabulating, and compiling data from the clinical practice of vascular surgery. One hundred sixty-five members of the Society submitted 8,800 cases for data entry and analysis. The data fields considered were age, smoking habits, presence of diabetes, operative indications, operative procedures, graft materials, follow-up, morbidity, and causes of death. Data analysis considered only the follow-up results within the immediate 30 day perioperative period.
Requests for reprints should be addressed to S. M. Greenstone, MD, Society for Clinical Vascular Surgery, 5400 Balboa Boulevard, Suite 225. Encino, California 91316. This paper was presented at the 1 lth Annual Meeting of the Society for Clinical Vascular Surgery, Palm Springs, California, March 23-27, 1983.
162
Comments The initial thrust of the registry committee was directed to design the data entry form. Following multiple revisions, the form ultimately evolved into an alpha-numeric code sheet for easy data entry into a computer. The need to have a simplified form which required little time and effort on the part of the operating surgeon was recognized as practical and essential for wide acceptance. The second practical aspect of the study was to ensure security of data to protect the sensitivity of individuals with respect to exposure of the nature of their practice and results, as well as the confidentiality of the surgeon-patient relationship. This matter was addressed by randomly assigning each member an alpha-numeric identification number by the secretary of the Society. The number was kept in confidence by the secretary’s office and was not shared with the central registry office. Each surgeon was instructed to use only his identification code on each completed case form. Members then sent the data sheets directly to the central registry office in plain envelopes without other identification. The information was entered into the computer. The third practical aspect of this study was the application of data obtained both to the field of vascular surgery and to the contributing vascular surgeon. Programs were developed which enable retrieval and analysis of the entire bulk of data, subgroups of data, and particular points of interest. Assessment of the data is available for presentation to the Society and its membership as well as for publication. The report of each surgeon’s practice was returned from the central registry office to the office of the secretary of the Society in a sealed envelope which was externally labelled only with an identification number. The envelope was then addressed and mailed to the individual surgeon. In this way neither
The American Journal of Surgery
Large Scale Vascular Registry
the secretary nor the central registry offices had any means of matching data with identification. Complete anonymity of an individual surgeon’s data was preserved. Each surgeon received a copy of his personal experience together with a copy of the total experience which enabled him to assess and judge his own level of practice with that of his peers. Following voluntary participation, in 1982 the membership of The Society for Clinical Vascular Surgery voted to make the participation of a surgeon member in the registry by submission of data entry sheets of his clinical practice for the year a requirement for continued membership in the Society.
Volume 148, August 1993
Summary The preliminary study carried out on a voluntary basis, has illustrated the feasibility of a large scale vascular registry serving as a benchmark against which a standard of practice of vascular surgery can be assessed. An initial experience with 165 surgeons active in the clinical practice of surgery (contributing 8,800 major vascular reconstructive cases in a 9 month period) suggests access to an enormous data base of vascular surgery practice against which community standards may be measured.
163
Preliminary Experience With a Large Scale Vascular Registry
Allastair M. Karmody, MD, Albany, New York Robert M. Blumenberg, MD, Schenectady,
New York
C. Allen Wall, MD, San Francisco, California
One of the most attractive features of the discipline of vascular surgery is the clear delineation of an end-point. This makes recording easier because success renders a patient symptom-free, signs of benefit are easy to determine, and physical measurements can be made with considerable validity. The bases of published reports on vascular surgery have been the experience, results, and wisdom of individuals, small groups, or well-circumscribed institutions. When multiinstitutional surveys have been collected, analyzed, and published, an area of special interest is generally the focal point. In an effort to obtain a broader, current, and more realistic data base, the Society for Clinical Vascular Surgery, an organization of 471 clinically active surgeons for whom vascular surgery is a major component of their clinical practice, initiated a study into the practical aspects of establishing a vascular registry. An initial 3 month pilot study by a small group in 1981 was carried out to define parameters. A larger study encompassing the 9 month period from April 1,1982 through December 31,1982 was undertaken on a voluntary basis by the membership to assess the practical aspects of collecting, tabulating, and compiling data from the clinical practice of vascular surgery. One hundred sixty-five members of the Society submitted 8,800 cases for data entry and analysis. The data fields considered were age, smoking habits, presence of diabetes, operative indications, operative procedures, graft materials, follow-up, morbidity, and causes of death. Data analysis considered only the follow-up results within the immediate 30 day perioperative period.
Requests for reprints should be addressed to S. M. Greenstone, MD, Society for Clinical Vascular Surgery, 5400 Balboa Boulevard, Suite 225. Encino, California 91316. This paper was presented at the 1 lth Annual Meeting of the Society for Clinical Vascular Surgery, Palm Springs, California, March 23-27, 1983.
162
Comments The initial thrust of the registry committee was directed to design the data entry form. Following multiple revisions, the form ultimately evolved into an alpha-numeric code sheet for easy data entry into a computer. The need to have a simplified form which required little time and effort on the part of the operating surgeon was recognized as practical and essential for wide acceptance. The second practical aspect of the study was to ensure security of data to protect the sensitivity of individuals with respect to exposure of the nature of their practice and results, as well as the confidentiality of the surgeon-patient relationship. This matter was addressed by randomly assigning each member an alpha-numeric identification number by the secretary of the Society. The number was kept in confidence by the secretary’s office and was not shared with the central registry office. Each surgeon was instructed to use only his identification code on each completed case form. Members then sent the data sheets directly to the central registry office in plain envelopes without other identification. The information was entered into the computer. The third practical aspect of this study was the application of data obtained both to the field of vascular surgery and to the contributing vascular surgeon. Programs were developed which enable retrieval and analysis of the entire bulk of data, subgroups of data, and particular points of interest. Assessment of the data is available for presentation to the Society and its membership as well as for publication. The report of each surgeon’s practice was returned from the central registry office to the office of the secretary of the Society in a sealed envelope which was externally labelled only with an identification number. The envelope was then addressed and mailed to the individual surgeon. In this way neither
The American Journal of Surgery
Large Scale Vascular Registry
the secretary nor the central registry offices had any means of matching data with identification. Complete anonymity of an individual surgeon’s data was preserved. Each surgeon received a copy of his personal experience together with a copy of the total experience which enabled him to assess and judge his own level of practice with that of his peers. Following voluntary participation, in 1982 the membership of The Society for Clinical Vascular Surgery voted to make the participation of a surgeon member in the registry by submission of data entry sheets of his clinical practice for the year a requirement for continued membership in the Society.
Volume 148, August 1993
Summary The preliminary study carried out on a voluntary basis, has illustrated the feasibility of a large scale vascular registry serving as a benchmark against which a standard of practice of vascular surgery can be assessed. An initial experience with 165 surgeons active in the clinical practice of surgery (contributing 8,800 major vascular reconstructive cases in a 9 month period) suggests access to an enormous data base of vascular surgery practice against which community standards may be measured.
163