Quality of provided care in vascular surgery : outcome assessment & improvement strategies

Abstract

The aim of this thesis was to evaluate the quality of care in vascular surgery in end-stage renal disease (ESRD) and peripheral arterial occlusive disease (PAOD): intermittent claudication (IC) and critical lower limb ischaemia (CLI) patients. Therefore firstly it focused on the improvement of the quality of perioperative patient management concerning: (1) a systematic review concerning all quality initiatives in vascular surgery was conducted, (2) an assessed of the implementation of established recommended SP measures in patients with PAOD was established and (3) an evaluation of the implementation of a new optimised care protocol (OCP) outlined in a multidisciplinary meeting was done. Then, it further focused mainly on AEs (registration, occurrence, consequences) of PAOD patients. A (1) determination of risk factors for adverse events (AE) occurrence by assessing three different health care facilities was assessed, (2) an evaluation of the occurrence of cardiac AE after primary lower extremity arterial revascularization (LEAR) for CLI in order to evaluate the impact of cardiac AEs on the clinical outcome was done and (3) a calculation of the average estimated total costs of AEs after treatment for PAOD was performed. Furthermore, the thesis focussed on the quality of life (QOL) of PAOD patients after primary LEAR, concerning (1) the role of social support on the outcome and (2) the improvement of functional status after primary LEAR.