The influence of vascular certification on lower extremity revascularization at one institution.
The potential impact of vascular certification on the practice of vascular surgery at Maricopa Medical Center (Phoenix, AZ) was analyzed by comparison of lower extremity revascularization results over consecutive 2-year periods before (Period I) and after (Period II) institution of vascular surgery service. The overall setting (county hospital, surgical residency) and ancillary services (Anesthesia, Intensive Care Unit, Radiology) were unchanged, except for the authors' use of invasive hemodynamic support. In Period I, there were 49 cases (30 inflow, 19 outflow) with 14 per cent (7/49) mortality, 32 per cent (21/67) limb thrombosis or embolus, and 10 per cent (5/49) graft infection; 80 per cent (39/49) of operations were done for claudication; 20 per cent (10/49) were done for inappropriate indications (P less than 0.005). In Period II, there were 110 cases (47 inflow, 63 outflow). The increase in cases was predominantly due to increased use of extra-anatomic inflow and complex infrapopliteal outflow reconstructions. Seventy per cent (77/110) of operations were done for limb salvage; of 17 aortic cases, 3 were "re-do's" and 5 underwent simultaneous renal revascularization. There was a 3 per cent (4/110) mortality (P less than 0.025), 11 per cent (13/137) limb thrombosis or embolus (P less than 0.005), and no graft infections (P less than 0.001). Lower extremity revascularization delivered by certified vascular surgeons was offered to more patients with lower overall mortality and morbidity rates after more thorough diagnostic work-up and for more appropriate indications, with concomitant use of more refined vascular techniques/procedures.(ABSTRACT TRUNCATED AT 250 WORDS)
Bunt
T J
TJ
Department of Surgery, Maricopa Medical Center, Phoenix, Arizona 85008.
Malone
J M
JM
D000367:Age Factors; D001130:Arizona / Q000453:epidemiology; D002568:Certification / Q000706:statistics & numerical data; D006766:Hospitals, County / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000601:surgery*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D013503:Surgery Department, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D014652:Vascular Diseases / Q000453:epidemiology / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000592:standards* / Q000706:statistics & numerical data; D000078329:Workforce