TY - JOUR
T1 - Transcatheter arterial revascularization outcomes at vascular and general surgery teaching hospitals and nonteaching hospitals are comparable
AU - Bhamidipati, Castigliano M.
AU - Lapar, Damien J.
AU - Stukenborg, George J.
AU - Lutz, Charles J.
AU - Tracci, Margaret C.
AU - Cherry, Kenneth J.
AU - Upchurch, Gilbert R.
AU - Kern, John A.
PY - 2012/7
Y1 - 2012/7
N2 - 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.
AB - 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.
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U2 - 10.1016/j.jvs.2011.12.083
DO - 10.1016/j.jvs.2011.12.083
M3 - Article
C2 - 22583853
AN - SCOPUS:84862989082
SN - 0741-5214
VL - 56
SP - 247-255.e2
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
IS - 1
ER -