Quality review and education as method of improving guideline adherence for medication prescription and outcomes among vascular interventionalists performing non-cardiac vascular surgeries

Abstract

Background: Medical management of patients undergoing non-cardiac vascular procedures often sub-optimally follow evidence based guidelines. We hypothesized that feedback to practitioners in regards to outcomes and medications prescribed would improve care. Methods: With conversion to new database in 2015 that allowed for more comprehensive tracking of vascular surgery outcomes, a decision was made to share these data with practitioners on regular basis as well as relay medications prescribed at discharge. Carotid and abdominal aortic surgeries were evaluated. The most frequent format for presentation of data was vascular morbidity and mortality conference. Medications included in presentations were antiplatelet and statin therapies. Comparisons were made between adherence to guideline based therapies 2 years before and 2 years after new database implementation. ACE inhibitor/aldosterone receptor blocker (ARB) therapy prescribing data were not included in these presentations. SAS Enterprise Guide 7.1 and R 3.6.1 software used for analysis. Results: 826 patients were evaluated. 400 patients were in pre new database implementation and 426 were included after implementation. No significant difference found with prescribing of ACE inhibitors/ARB, changing only from 47 to 48%. There was difference with univariate analysis of antiplatelet and statin prescribing. Antiplatelet prescribing improved from 89 to 93%, Odds Ratio (OR) = 1.7 (95% confidence interval, 1-2.8) and statin prescribing improved from 74 to 86%, OR= 2.1 (95% confidence interval, 1.5-3). Access site and bleeding complications also demonstrated improvement. See Figure. Conclusion: Regular feedback to vascular practitioners improves adherence to guideline based therapies and can improve surgical outcomes