Transcatheter arterial revascularization outcomes at vascular and general surgery teaching hospitals and nonteaching hospitals are comparable

• Published in: Journal of vascular surgery 2012-07, Vol.56 (1), p.247-255.e2
• Main Authors: Bhamidipati, Castigliano M., DO, MSc, LaPar, Damien J., MD, MSc, Stukenborg, George J., PhD, Lutz, Charles J., MD, Tracci, Margaret C., MD, JD, Cherry, Kenneth J., MD, Upchurch, Gilbert R., MD, Kern, John A., MD
• Format: Article
• Language: English
• Subjects: Aged; Aortic Aneurysm, Abdominal - surgery; Aortic Aneurysm, Thoracic - surgery; Biological and medical sciences; Cardiovascular system; Catheterization - standards; Chi-Square Distribution; Education, Medical, Graduate; Female; Hospitals, Teaching - standards; Humans; Internship and Residency; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Outcome Assessment (Health Care); Peripheral Vascular Diseases - surgery; Postoperative Complications - epidemiology; Regression Analysis; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; United States - epidemiology; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures - mortality; Vascular Surgical Procedures - standards
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2011.12.083

Background Outcomes following transcatheter interventions at vascular and general surgery teaching hospitals (STH) are unknown. We examine whether surgery training programs influence clinically relevant outcomes after commonly performed endovascular procedures. Methods Using an all-payer inpatient care database from 2008, we selected adults who underwent either endovascular carotid stenting, endografting of descending thoracic aortic aneurysm, endovascular abdominal aortic aneurysm repair, or peripheral arterial revascularization. Patients were stratified by procedures completed at Surgery Teaching (Participate in Accreditation Council for Graduate Medical Education [ACGME]-accredited vascular and general surgery programs), STH, or nonteaching hospitals (NTH). Hierarchical regression models assessed adverse outcomes and in-hospital mortality among groups. Results Of the 175,698 records, 44% of the patients were treated at STH, while 56% underwent procedures at NTH. The adjusted odds ratio of any complication or mortality at STH and NTH were similar. Transfers, weekend admissions, and nonelective cases were higher at STH ( P < .001, respectively). Paradoxically, STH treated fewer patients with more than three comorbidities compared with NTH (STH: 47% vs NTH: 53%; P < .001). Surgical teaching status did not lower the adjusted odds of mortality for any procedure. Moreover, the occurrence of any complication (adjusted odds ratios, 0.9; 95% confidence interval, .82-1.14; P = .69) and mortality (adjusted odds ratios, 0.9; 95% confidence interval, .74-1.22; P = .67) were equivalent between vascular and general STH. Conclusions Following commonly performed transcatheter vascular procedures, and despite more transfers, weekend admissions, and nonelective procedures completed at STH, complications, and mortality were comparable across centers.