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    Peripheral arterial interventions: trends in market share and outcomes by specialty, 1998-2005

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    Authors
    Eslami, Mohammad H.
    Csikesz, Nicholas G.
    Schanzer, Andres
    Messina, Louis M.
    UMass Chan Affiliations
    Department of Surgery
    Document Type
    Journal Article
    Publication Date
    2009-08-26
    Keywords
    Aged
    Arteries
    Cardiology Service, Hospital
    Clinical Competence
    Female
    Health Care Sector
    Health Care Surveys
    Hospital Mortality
    Hospitals, Teaching
    Humans
    Iatrogenic Disease
    Inpatients
    Logistic Models
    Lower Extremity
    Male
    Outcome and Process Assessment (Health Care)
    Peripheral Vascular Diseases
    Quality Indicators, Health Care
    Radiography, Interventional
    Retrospective Studies
    Risk Assessment
    Risk Factors
    Time Factors
    Treatment Outcome
    United States
    Vascular Surgical Procedures
    Wounds and Injuries
    Surgery
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    Link to Full Text
    http://dx.doi.org/10.1016/j.jvs.2009.06.013
    Abstract
    OBJECTIVE: Vascular surgeons (VS), interventional cardiologists (IC), and interventional radiologists (IR) perform peripheral arterial interventions (PAI). In this study, we reviewed market share trends and compared outcomes for each specialty using the National Inpatient Sample (NIS). METHODS: Patient discharges for PAI (1998-2005) were identified based on ICD9-CM procedure codes. The provider's specialty was identified by a specialty-specific algorithm and analyzed using SAS 9.1 (SAS Institute, Cary, NC). Market share trends and distribution of cases at teaching versus non-teaching hospitals were evaluated. Primary outcome measures were in-hospital mortality and iatrogenic arterial injuries (IAI). Multivariate logistic regression was performed to identify independent predictors of post-procedure morbidity and mortality. RESULTS: The number of cases identified was 23,825. From 1998 to 2005, IR's market share decreased six-fold (1998: 33% to 2005: 5.6%) whereas VS market share increased from 27% to 43% and IC from 10% to 29% (P < .05). A similar but more pronounced trend was observed at teaching hospitals. In-hospital mortality rate was highest for IR (2.1 IR% vs 1.2% VS and 0.6% IC; P < .001). Post-procedure IAI was highest in the IC group (1.3% vs IR 0.9% and 0.5% VS; P < .05). Compared with VS, the mortality rate was 1.62 times higher for IR patients (odds ratio [OR]: 1.62, 95% confidence interval [CI]: 1.16-2.24) and IAI was 2.44 times higher for IC (OR: 2.44, 95% CI: 1.63-3.66) and 1.75 times higher for IR (OR: 1.75, 95% CI: 1.08-2.81) patients. CONCLUSIONS: IR market share of PAI has precipitously declined while those of VS and IC have increased significantly. Vascular surgeons had the lowest overall morbidity and mortality of all groups. Increase in the number of endovascularly-trained VS with better access to fluoroscopy units may further increase VS's market share.
    Source
    J Vasc Surg. 2009 Nov;50(5):1071-8. Epub 2009 Aug 22. Link to article on publisher's site
    DOI
    10.1016/j.jvs.2009.06.013
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/49676
    PubMed ID
    19703759
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jvs.2009.06.013
    Scopus Count
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    UMass Chan Faculty and Researcher Publications

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