Professor Domenico Palombo of the Mauriziano Hospital in Turin talked to Vascular News about the Italian National Registry.
In 1998, Domenico Palombo as President of the Italian College of the Consultants in Vascular Surgery, with Dr F. Peinetti, organised the first national registry in Italy. Initially, this was aimed solely at ‘non academic units’, but after two years, the Italian Society of Vascular Surgery endorsed the Registry. As an Official Registry of the Italian Society of Vascular and Endovascular Surgery it was extended to include academic units. “Now the Registry is open to all Vascular Surgery Units,” said Palombo. “Sixty percent of the units adhered in 2001 and I was officially confirmed as the registry coordinator.”
Palombo then described the problems that the registry faced:
To fill-up all the fields of such an articulated tool, either time and/or medical informatic abilities are required.
The registry includes a field concerning the follow-up at 30 days, which requires contacting the patients after the outpatient date.
The necessity to create a tool that in most cases had to be integrated in the different hospital informatic data bank systems.
“Philosophically it is hard to create the awareness that, even the registry requires time and energy, it is a reality of essential importance to obtain national surgical data and allow their use for the National and for the International Scientific Community,” said Palombo.
“From a theoretically point of view all vascular units agreed to participate in the registry, nevertheless the participation although very consistent is not
yet complete.”
Much progress has been made in the collection of data. The creation of an Operative Commission of unit representatives (one representative per unit) for the registry data collection has been fundamental. Practically every unit nominates a representative responsible for data collection and data export and delivery (by disk or by e-mail). Two annual meetings have been established, in order to focus on current problems, to plan implementing strategies and to create further consensus about the registry.
Technically the registry is a Microsoft Access database composed of different fields containing patient’s data, focusing on the pathologic in-patient characteristics and on the surgical procedure performed. Risk markers are included, in order to identify predictive factors for adverse events. This is a fundamental target for a country where specific risk stratification in vascular surgery has never existed.
The National Registry 2001 report was officially presented in Cagliari, during the 2002 congress of the Italian Society of Vascular and Endovascular Surgery (SICVE). “Actually, 62% of the Italian vascular surgery centres regularly send us their data. In the group all major centres are included and compliance is progressively increasing,” said Palombo.
Most significant data (2001):
Demographic data
Number of patients: 35,507
Male: 58.5%
Female: 39.9%
Mean age: 64.37(+-14)
Procedure data
Overall procedure number: 34,848
Supra aortic trunks: 6,366 (18.8%)
Aorto-iliac aneurysm surgery: 3,510 (10.1%)
Varicose veins surgery: 10,485 (30.1%)
According to Palombo, the registry is the first “photograph” of the Italian vascular activity and it includes all the types of vascular disease treated, all the types of surgical and endovascular procedures and their results. These data should allow the society to exercise an audit of the surgical centres, and to establish a good partnership with the different Regional Councils and with the National Health Ministry for future activity in programme creation and in quality control. More over it will be an important feedback system encouraging, in every centre, a more conscious and quality controlled activity.
Finally the registry will allow Italy to compare its report activity with that of other European countries.
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