Understanding variation in the management of AAA in the UK: composition and function of multidisciplinary team meetings and information resources provided to patients

Objective: Variation in abdominal aortic aneurysm (AAA) repair practice is reported nationally. This may be due to gaps in the evidence supporting clinical decision-making, historical preferences in repair practices within centres, and variation in decision-making in multidisciplinary team (MDT) meetings. This study aims to understand the reasons behind variation in AAA repair practices in UK NHS vascular centres in terms of MDT discussions, written patient information and patient involvement in decision-making.

Design: An observational, cross-sectional organisational survey of NHS vascular centres.

Methods: Consultant vascular surgeons at 50/72 UK centres were invited to participate in a researcher-administered survey. Centres were categorised using 2022 National Vascular Registry (NVR) dataset into low versus high endovascular aneurysm repair (EVAR) rates and low versus high rates of MDT review; the sample was stratified to achieve balance across the four groups. The survey captured centre characteristics, individual clinical decision-making practices, integration of patient perspectives within MDT decision-making and information provision.

Results: Seventeen clinicians completed the study (24% of centres). All centres hold MDT meetings but differ in composition, skills mix, remit and delivery. Variation was observed in how clinicians present risk information, elicit patient preferences and manage someone not deemed suitable for (or declining) repair. Written information given to patients to supplement consultations does not adequately describe the conservative management option.

Conclusions: This survey highlights variation in preparation and management of people under consideration for AAA repair across UK vascular centres. Improving input of other specialties, improving the presentation of risk to patients and defining active, non-surgical ‘conservative management’ pathways may help to improve the consistency of practice between vascular centres.