Outcomes of percutaneous lower extremity procedures depend more on indication than physician specialty

  • J.R. W
  • T.H. Y
  • R.A. C
 et al. 
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Objectives: Outcomes of percutaneous lower extremity procedures (PLEP) have been recently linked to physician specialty. Unfortunately, the indication for intervention was not reported. We sought to compare outcomes between specialties performing PLEP for different indications in a recent statewide inpatient discharge data set. Methods: The Florida hospital discharge data from 2005 to 2009 was reviewed for patients with PLEP during hospitalization. We assigned physician specialty as interventional radiology (IR), interventional cardiology (IC), or vascular surgery (VS) based on physician-associated procedures. Clinical indication was claudication or critical limb ischemia (CLI). We limited our analysis to patients without concomitant open surgery during hospitalization. We compared mortality, length of stay (LOS), major use of intensive care unit (ICU), discharge disposition, and total charges between specialties with logistic regression models, both unadjusted and adjusted for demographic and clinical characteristics. Results: A total of 15,398 patients (47% with CLI) had a PLEP. IC performed the majority of procedures on claudicant patients (VS 30%, IC 57%, IR 13%), and VS performed the majority of procedures on CLI patients (VS 50%, IC 22%, IR 27%). VS and IR were more likely than IC to treat CLI patients (VS 59%, IR 65%, IC 26%; P < .001). Among CLI patients, there was no difference in mortality rates between the three specialties in unadjusted analysis (VS 2.3%, IR 3.0%, IC 2.1%, P = .124), nor after adjustment (odds ratio [OR] VS, reference; IR, 1.05; IC, 0.82; P = NS for both). However, compared with VS, IR-treated patients were less likely to be discharged home (OR, 0.73; P < .001), LOS was longer (beta, 1.15 days; P < .001), major ICU use was more common (OR, 1.48; P < .001), and total charges were higher (beta, $3267; P = .001). CLI was most predictive for death (OR, 4.02; P

Author-supplied keywords

  • *human
  • *leg
  • *physician
  • *procedures
  • *society
  • *vascular surgery
  • United States
  • adverse outcome
  • cardiology
  • claudication
  • critical limb ischemia
  • death
  • hospital discharge
  • hospital patient
  • hospitalization
  • intensive care unit
  • interventional radiology
  • length of stay
  • logistic regression analysis
  • model
  • mortality
  • patient
  • risk
  • surgery

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  • Wallace J.R.

  • Yuo T.H.

  • Chaer R.A.

  • Makaroun M.S.

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