The pitfalls of establishing a statewide vascular registry: The South Carolina experience

Concerned about the inadequacy of a centralized database and the importance of low morbidity and mortality on carotid endarterectomy efficacy, the Sou th Carolina Vascular Surgical Society prospectively instituted a computer r egistry for carotid procedures performed by its members, to establish a sta tewide standard of practice. From January 1994 through December 1997, 23 of the 30 physician members voluntarily registered data on 1652 carotid opera tions at 14 hospitals into a central database. Blinded results were reviewe d biannually. Complete data (1995-1997) were available for 1199 cases. The patients tended to be >64 years old (72%), male (62%), and white (93%). Car otid endarterectomy was the most frequently performed operation (90%). Peri operative complications (less than or equal to 30 days) occurred in 173 pat ients (14.4%), including stroke (n = 19; 1.6%), death (n = 8; 0.7%), and st roke/death (n = 25; 2.0%). Although 23 surgeons (77% of the society) contri buted some data, only 10 surgeons (33%) contributed complete data on >10 pa tients/year. Despite biannual efforts to boost participation, case entry re mained stable (1994, 358; 1995, 347; 1996, 425; and 1997, 427), representin g about one-third of the estimated carotid procedures performed in the stat e during that period. The cost of the registry was approximately $11,500. A udit of 8 surgeons revealed a >95 per cent match against the statewide disc harge database and low error rate versus independent medical record review. This experience confirms that excellent outcomes after carotid endarterect omy are not limited to a few select centers and can be accomplished by adeq uately trained surgeons in a variety of institutional settings. Incomplete physician participation, however, inevitably raises questions about the uti lity of such efforts. Until volunteer registries induce full participation by heightening perceived physician benefit, their role will remain limited for future outcomes research.