Since 2013 it is mandatory for all centers in the Netherlands to register outcomes of all aortic aneurysm repairs in the Dutch Surgical Aneurysm Audit (DSAA). Analysis of DSAA data shows a reduction in mortality and complications after endovascular and open surgery for infrarenal abdominal aortic aneurysm (AAA) from 2015-2019. The question is however whether a quality registry alone is sufficient to improve the quality of care, since it is up to the individual hospital to act on DSAA information. This commentary discusses targets for further improvement of outcomes of AAA surgery such as structural and transparent feedback on results, opportunities to learn from "best practices" and to look beyond quality scores and act instead. It further highlights the call for action to reduce the high mortality in females after open AAA repair and to avoid unnecessary operations under the threshold for AAA repair.
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