Peripheral arterial interventions: trends in market share and outcomes by specialty, 1998-2005
Name:
Publisher version
View Source
Access full-text PDFOpen Access
View Source
Check access options
Check access options
UMass Chan Affiliations
Department of SurgeryDocument Type
Journal ArticlePublication Date
2009-08-26Keywords
AgedArteries
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
Metadata
Show full item recordAbstract
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 siteDOI
10.1016/j.jvs.2009.06.013Permanent Link to this Item
http://hdl.handle.net/20.500.14038/49676PubMed ID
19703759Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.jvs.2009.06.013