Journal article
Impact of Hospital Volume on Outcomes of Lower Extremity Endovascular Interventions (Insights from the Nationwide Inpatient Sample [2006 to 2011])
The American journal of cardiology, Vol.116(5), pp.791-800
09/01/2015
DOI: 10.1016/j.amjcard.2015.05.050
PMID: 26100585
Abstract
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 <0.001), female gender (1.28, 1.12 to 1.46, p <0.001), baseline co-morbidity status as depicted by a greater Charlson co-morbidity index score (≥2: 4.32, 3.45 to 5.40, p <0.001), emergent or urgent admissions(2.48, 2.14 to 2.88, p <0.001), and weekend admissions (1.53, 1.26 to 1.86, p <0.001) to be significant predictors of primary outcome. An increasing hospital volume quartile was independently predictive of improved primary (0.65, 0.52 to 0.82, p <0.001 for the fourth quartile) and secondary (0.85, 0.73 to 0.97, 0.02 for the fourth quartile) outcomes and lower amputation rates (0.52, 0.45 to 0.61, p <0.001). A significant reduction hospitalization costs ($-3,889, -5,318 to -2,459, p <0.001) was also seen in high volume centers. In conclusion, a greater hospital procedural volume is associated with superior outcomes after peripheral endovascular interventions in terms of inhospital mortality, complications, and hospitalization costs.
Details
- Title: Subtitle
- Impact of Hospital Volume on Outcomes of Lower Extremity Endovascular Interventions (Insights from the Nationwide Inpatient Sample [2006 to 2011])
- Creators
- Shilpkumar Arora - Internal Medicine Department, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New YorkSidakpal S Panaich - Cardiology Department, Detroit Medical Center, Detroit, MichiganNilay Patel - Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New JerseyNileshkumar Patel - Internal Medicine Department, Staten Island University Hospital, New York, New YorkSopan Lahewala - Internal Medicine Department, Jersey City Medical Center, Jersey City, New JerseyShantanu Solanki - Internal Medicine Department, New York Medical College at Westchester Medical Center, Valhalla, New YorkParshva Patel - Internal Medicine Department, Drexel School of Public Health, Philadelphia, PennsylvaniaAchint Patel - Internal Medicine Department, Icahn School of Public Health at Mt. Sinai, New York, New YorkSohilkumar Manvar - Cardiology Department, Detroit Medical Center, Detroit, MichiganChirag Savani - Internal Medicine Department, New York Medical College, Valhalla, New YorkByomesh Tripathi - Internal Medicine Department, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New YorkBadal Thakkar - Cardiology Department, Detroit Medical Center, Detroit, MichiganSunny Jhamnani - Cardiology Department, Yale School of Medicine, New Haven, ConnecticutVikas Singh - Cardiology Department, University of Miami Miller School of Medicine, Miami, FloridaSamir Patel - Internal Medicine Department, Western Reserve University, Youngstown, OhioJay Patel - Cardiology Department, Detroit Medical Center, Detroit, MichiganRonak Bhimani - Internal Medicine Department, St. Vincent Charity Medical Center, Cleveland, OhioTamam Mohamad - Cardiology Department, Detroit Medical Center, Detroit, MichiganMichael S Remetz - Cardiology Department, Yale School of Medicine, New Haven, ConnecticutJeptha P Curtis - Cardiology Department, Yale School of Medicine, New Haven, ConnecticutRamak R Attaran - Cardiology Department, Yale School of Medicine, New Haven, ConnecticutCindy Grines - Cardiology Department, Detroit Medical Center, Detroit, MichiganCarlos Ignacio Mena - Cardiology Department, Yale School of Medicine, New Haven, ConnecticutMichael Cleman - Cardiology Department, Yale School of Medicine, New Haven, ConnecticutJohn Forrest - Cardiology Department, Yale School of Medicine, New Haven, ConnecticutApurva O Badheka - Cardiology Department, Yale School of Medicine, New Haven, Connecticut. Electronic address: apurva.badheka@yale.edu
- Resource Type
- Journal article
- Publication Details
- The American journal of cardiology, Vol.116(5), pp.791-800
- DOI
- 10.1016/j.amjcard.2015.05.050
- PMID
- 26100585
- ISSN
- 0002-9149
- eISSN
- 1879-1913
- Language
- English
- Date published
- 09/01/2015
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984094367002771
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