Intravascular Ultrasound in Lower Extremity Peripheral Vascular Interventions: Variation in Utilization and Impact on In-Hospital Outcomes From the Nationwide Inpatient Sample (2006-2011)

Sidakpal S Panaich; Shilpkumar Arora; Nilay Patel; Nileshkumar J Patel; Chirag Savani; Achint Patel; Badal Thakkar; Vikas Singh; Samir Patel; Nish Patel; Kanishk Agnihotri; Parth Bhatt; Abhishek Deshmukh; Vishal Gupta; Ramak R Attaran; Carlos I Mena; Cindy L Grines; Michael Cleman; John K Forrest; Apurva O Badheka

doi:10.1177/1526602815620780

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Intravascular Ultrasound in Lower Extremity Peripheral Vascular Interventions: Variation in Utilization and Impact on In-Hospital Outcomes From the Nationwide Inpatient Sample (2006-2011)

Journal article

Peer reviewed

Intravascular Ultrasound in Lower Extremity Peripheral Vascular Interventions: Variation in Utilization and Impact on In-Hospital Outcomes From the Nationwide Inpatient Sample (2006-2011)

Sidakpal S Panaich, Shilpkumar Arora, Nilay Patel, Nileshkumar J Patel, Chirag Savani, Achint Patel, Badal Thakkar, Vikas Singh, Samir Patel, Nish Patel, …

Journal of endovascular therapy, Vol.23(1), pp.65-75

02/2016

DOI: 10.1177/1526602815620780

PMID: 26637836

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Abstract

To examine the impact of intravascular ultrasound (IVUS) utilization during lower limb endovascular interventions as regards postprocedural complications and amputation. The study cohort was derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database between the years 2006 and 2011. Peripheral endovascular interventions were identified using appropriate ICD-9 procedure codes. Two-level hierarchical multivariate mixed models were created. The co-primary outcomes were in-hospital mortality and amputation; the secondary outcome was postprocedural complications. Model results are given as the odds ratio (OR) and 95% confidence interval (CI). Hospitalization costs were also assessed. Overall, among the 92,714 patients extracted from the database during the observation period, IVUS was used in 1299 (1.4%) patients. IVUS utilization during lower extremity peripheral vascular procedures was independently predictive of a lower rate of postprocedural complications (OR 0.80, 95% CI 0.66 to 0.99, p=0.037) as well as lower amputation rates (OR 0.59, 95% CI 0.45 to 0.77, p<0.001) without any significant impact on in-hospital mortality. Multivariate analysis also revealed IVUS utilization to be predictive of a nonsignificant increase in hospitalization costs ($1333, 95% CI -$167 to +$2833, p=0.082). IVUS use during lower limb endovascular interventions is predictive of lower postprocedural complication and amputation rates with a nonsignificant increase in hospitalization costs.

Hospital Costs

Multivariate Analysis

Practice Patterns, Physicians' - economics

Peripheral Vascular Diseases - therapy

United States

Humans

Middle Aged

Male

Young Adult

Time Factors

Endovascular Procedures - economics

Amputation

Aged, 80 and over

Adult

Female

Odds Ratio

Ultrasonography, Interventional - economics

Databases, Factual

Peripheral Vascular Diseases - diagnostic imaging

Limb Salvage

Hospital Mortality

Endovascular Procedures - adverse effects

Risk Factors

Ultrasonography, Interventional - utilization

Linear Models

Treatment Outcome

Endovascular Procedures - mortality

Chi-Square Distribution

Peripheral Vascular Diseases - surgery

Peripheral Vascular Diseases - mortality

Endovascular Procedures - utilization

Cost-Benefit Analysis

Adolescent

Aged

Lower Extremity - blood supply

Details

Title: Subtitle: Intravascular Ultrasound in Lower Extremity Peripheral Vascular Interventions: Variation in Utilization and Impact on In-Hospital Outcomes From the Nationwide Inpatient Sample (2006-2011)
Creators: Sidakpal S Panaich - Borgess Medical Centre, Kalamazoo, MI, USA
Shilpkumar Arora - Mount Sinai St. Luke's Roosevelt Hospital, New York, NY, USA
Nilay Patel - Saint Peter's University Hospital, New Brunswick, NJ, USA
Nileshkumar J Patel - University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
Chirag Savani - New York Medical College, Valhalla, NY, USA
Achint Patel - Icahn School of Public Health at Mount Sinai, New York, NY, USA
Badal Thakkar - Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
Vikas Singh - University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
Samir Patel - Western Reserve Health System, Youngstown, OH, USA
Nish Patel - University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
Kanishk Agnihotri - Saint Peter's University Hospital, New Brunswick, NJ, USA
Parth Bhatt - Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
Abhishek Deshmukh - Mayo Clinic, Rochester, MN, USA
Vishal Gupta - Borgess Medical Centre, Kalamazoo, MI, USA
Ramak R Attaran - Yale School of Medicine, New Haven, CT, USA
Carlos I Mena - Yale School of Medicine, New Haven, CT, USA
Cindy L Grines - Detroit Medical Center, Detroit, MI, USA
Michael Cleman - Yale School of Medicine, New Haven, CT, USA
John K Forrest - Yale School of Medicine, New Haven, CT, USA
Apurva O Badheka - The Everett Clinic, Everett, WA, USA apurva_badheka@yahoo.com
Resource Type: Journal article
Publication Details: Journal of endovascular therapy, Vol.23(1), pp.65-75
DOI: 10.1177/1526602815620780
PMID: 26637836
ISSN: 1526-6028
eISSN: 1545-1550
Language: English
Date published: 02/2016
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984094405902771

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