Impact of Hospital Procedural Volume on Outcomes After Endovascular Revascularization for Critical Limb Ischemia |
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| Institution: | 1. Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA;2. Department of Medicine, Weill Cornell Medicine–Qatar, Doha, Qatar;3. Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA;4. Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA;5. Division of Cardiology, Chandler Regional Medical Center, Chandler, Arizona, USA;6. Minneapolis Heart Institute at Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA;7. Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;8. Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA;9. Heart and Vascular Institute, University Hospitals, and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA |
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| Abstract: | ObjectivesThe aim of this study was to evaluate the interaction between hospital endovascular lower extremity revascularization (eLER) volume and outcomes after eLER for critical limb ischemia (CLI).BackgroundThere is a paucity of data on the relationship between hospital procedural volume and outcomes of eLER for CLI.MethodsThe authors queried the Nationwide Readmission Database (2013-2015) for hospitalized patients who underwent eLER for CLI. Hospitals were divided into tertiles according to annual eLER volume: low volume (<100 eLER procedures), moderate volume (100-550 eLER procedures), and high volume (>550 eLER procedures). Stepwise multivariable regression models were used. The main outcomes were in-hospital mortality and 30-day readmission with major adverse limb events, defined as the composite of amputation, acute limb ischemia, or repeat revascularization.ResultsAmong 145,785 hospitalizations for eLER for CLI, 5,199 (3.6%) were at low-volume eLER hospitals, 27,857 (19.1%) at moderate-volume eLER hospitals, and 112,728 (77.3%) at high-volume eLER hospitals. On multivariable analysis, there was no difference with regard to in-hospital mortality among moderate-volume hospitals (adjusted odds ratio OR]: 0.78; 95% CI: 0.60-1.01) and high-volume hospitals (adjusted OR: 0.84; 95% CI: 0.64-1.05) compared with low-volume hospitals. There was lower risk of in-hospital major amputation (adjusted OR: 0.82; 95% CI: 0.70-0.96) and minor amputation at high- versus low-volume hospitals. The length of hospital stay was shorter and discharges to nursing facilities were fewer among moderate- and high-volume hospitals compared with low-volume hospitals. Compared with low-volume hospitals, eLER for CLI at high-volume hospitals had a lower risk for 30-day readmission with major adverse limb events (adjusted OR: 0.83; 95% CI: 0.70-0.99), while there was no difference among moderate-volume hospitals (adjusted OR: 0.92; 95% CI: 0.77-1.10).ConclusionsThis nationwide observational analysis suggests that annual eLER volume does not influence in-hospital mortality after eLER for CLI. However, high eLER volume (>550 eLER procedures) was associated with better rates of limb preservation after eLER for CLI. |
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| Keywords: | adverse limb events critical limb ischemia endovascular revascularization procedural volume AKI"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"acute kidney injury CKD"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"chronic kidney disease CLI"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"critical limb ischemia eLER"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"endovascular lower extremity revascularization HCUP"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"Healthcare Cost and Utilization Project ICD-9"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"International Classification of Diseases-9th Revision IQR"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"interquartile range LER"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"lower extremity revascularization MALE"} {"#name":"keyword" "$":{"id":"kwrd0115"} "$$":[{"#name":"text" "_":"major adverse limb event(s) NRD"} {"#name":"keyword" "$":{"id":"kwrd0125"} "$$":[{"#name":"text" "_":"Nationwide Readmissions Database |
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