Impact of Hospital Volume on Outcomes of Lower Extremity Endovascular Interventions (Insights from the Nationwide Inpatient Sample [2006 to 2011])

• Published in: The American journal of cardiology 2015-09, Vol.116 (5), p.791-800
• Main Authors: Arora, Shilpkumar, MD, Panaich, Sidakpal S., MD, Patel, Nilay, MD, Patel, Nileshkumar, MD, Lahewala, Sopan, MD, Solanki, Shantanu, MD, Patel, Parshva, MD, Patel, Achint, MD, Manvar, Sohilkumar, MD, Savani, Chirag, MD, Tripathi, Byomesh, MD, Thakkar, Badal, MD, Jhamnani, Sunny, MD, Singh, Vikas, MD, Patel, Samir, MD, Patel, Jay, MD, Bhimani, Ronak, MD, Mohamad, Tamam, MD, Remetz, Michael S., MD, Curtis, Jeptha P., MD, Attaran, Ramak R., MD, Grines, Cindy, MD, Mena, Carlos Ignacio, MD, Cleman, Michael, MD, Forrest, John, MD, Badheka, Apurva O., MD, CCDS
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; Amputation; Cardiovascular; Codes; Comorbidity; Cost estimates; Endovascular Procedures - methods; Female; Follow-Up Studies; Health maintenance organizations; HMOs; Hospital Costs - trends; Hospital Mortality - trends; Hospitalization; Hospitals, High-Volume; Hospitals, Low-Volume; Humans; Incidence; Inpatients - statistics & numerical data; Ischemia; Lower Extremity - blood supply; Male; Middle Aged; Mortality; Peripheral Arterial Disease - economics; Peripheral Arterial Disease - mortality; Peripheral Arterial Disease - surgery; Postoperative Complications - economics; Postoperative Complications - epidemiology; Postoperative Period; Prognosis; Registries; Retrospective Studies; Studies; Teaching hospitals; United States - epidemiology; Young Adult
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2015.05.050

Our primary objective was to study postprocedural outcomes and hospitalization costs after peripheral endovascular interventions and the multivariate predictors affecting the outcomes with emphasis on hospital volume. The study cohort was derived from Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (2006 to 2011). Peripheral endovascular interventions were identified using appropriate International Classification of Diseases, Ninth Revision diagnostic and procedural codes. Annual institutional volumes were calculated using unique identification numbers and then divided into quartiles. Two-level hierarchical multivariate mixed models were created. The primary outcome was inhospital mortality; secondary outcome was a composite of inhospital mortality and postprocedural complications. Amputation rates and hospitalization costs were also assessed. Multivariate analysis (odds ratio, 95% confidence interval, p value) revealed age (1.46, 1.37 to 1.55, p