A population-level analysis: the influence of hospital type on trends in use and outcomes of lower extremity angioplasty.
OBJECTIVE
The use of infrainguinal percutaneous transluminal angioplasty (PTA) has increased, but patterns of use have not been well studied. Academic institutions (AIs) and nonacademic institutions (NAIs) may have developed different practice patterns and may have different associated outcomes.


METHODS
A retrospective statewide population-based administrative database was evaluated for patients undergoing PTA (1997-2004).


RESULTS
A total of 1718 patients underwent PTA for claudication (51.9%), rest pain (12.1%), and ulceration or gangrene (23.1%). The use of infrainguinal stents (62.4% vs 60.8%), elective procedures (76.3% vs 79.8%), in-hospital death (1.6% vs 2.2%), 30-day mortality (2.1% vs 3.3%), readmission rates (17.1% vs 15.9%), and reintervention rates after readmission (38.5% vs 42.9%) were similar between groups. Increased use of PTA was noted in AIs versus NAIs (239.5% vs 53.9%). AIs were significantly less likely to perform PTA for rest pain (7.5% vs 14.4%, P < .05).


CONCLUSIONS
AIs had a more recent increase in the use of PTA, but less often used PTA for patients with rest pain compared with NAIs. Both center types had higher than expected 30-day readmission and reintervention rates. Further understanding of the implementation and associated outcomes of PTA is required.
Vogel
Todd R
TR
Robert Wood Johnson Medical School, Division of Vascular Surgery, New Brunswick, New Jersey 08903-0019, USA. vogelto@umdnj.edu
Symons
Rebbecca G
RG
Flum
Dave R
DR
D000368:Aged; D000800:Angioplasty, Balloon / Q000706:statistics & numerical data* / Q000639:trends*; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D016491:Peripheral Vascular Diseases / Q000401:mortality / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019233:Retreatment / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology