Qualitätsindikatoren in der Karotischirurgie

Background: In vascular surgery, carotid artery stenosis is the only disease for which a German nationwide quality assurance is mandatory. In this article the quality indicators (QI) in the quality assurance procedures for carotid artery revascularization (carotid endarterectomy and carotid artery stenting) are described. Methods and definition of terms: The QIs are summarized and put into context with the literature. Furthermore, the different methods, such as QIs, key transparency figures and sentinel event indicators used to assess quality goals are described. Of these only QIs have an established reference range. Results: The aim of carotid revascularization is stroke prevention. The mandatory quality assurance procedure of carotid revascularization therefore pursues two quality goals measured with QIs: the correct indications and low complication rate of the primary endpoint stroke or death. The QI for outcome is measured by calculating the risk-adjusted ratio of the observed expected rate of periprocedural stroke or death. The nationwide adjusted risk over the years was 2.1–2.9% for carotid endarterectomy and 3.1–4.5% for carotid artery stenting. Conclusions: Carotid revascularization is the only procedure in vascular surgery that requires mandatory quality assurance by evaluating the correct indications and periprocedural stroke and fatality risks. This creates an important tool for ensuring the quality of care in invasive treatment of carotid stenosis in Germany. With increasing scientific evidence, a continuous adjustment of the QIs is necessary.