title: Lower extremity angioplasty: impact of practitioner specialty and volume on practice patterns and healthcare resource utilization.
abstract: OBJECTIVE
  Lower extremity percutaneous transluminal angioplasty (LE PTA) is currently performed by a variety of endovascular specialists. We hypothesized that cardiologists (CRD) and vascular surgeons (VAS) may have different practice patterns, indications for intervention, and hospital resource utilization.
  
  
  METHODS
  Using the State Inpatient Databases for New Jersey (2003-2007), patients with elective admission undergoing PTA procedures with indications of claudication, rest pain, and gangrene/ulceration were examined. Physician specialty was determined based on all procedures performed. We contrasted by specialty, the indication for LE PTA for the procedure, volume, and hospital resource utilization.
  
  
  RESULTS
  Of the 1887 cases of LE PTA, VAS performed 866 (45.9%) and CRD 1021 (54.1%) procedures. The mean patient age was 68.0 years (CRD) vs 70.7 years (VAS), P = .0163. Indications for intervention were compared for CRD vs VAS: claudication 80.7% vs 60.7%, (P < .002); rest pain 6.2% vs 16.0%, (P < .002); gangrene/ulceration 13.1% vs 23.3%, (P < .002). Stents (64.8% of cases) were utilized similarly among physicians (P = .18), and mean hospital length of stay were similar (2.38 days vs 2.41 days, P = .85). Hospital charges by indication varied between CRD vs VAS (all procedures: $49,748 vs $42,158 [P < .0001]). Revenue center charges were different between CRD vs VAS: medical surgical supply $19,128 vs $12,737, (P < .0001); pharmacy $1,959 vs $1,115, (P < .0001). Only 10.7% of CRD were high volume practitioners, compared with 36.8% among VAS (P < .05). High volume practitioners had significantly lower hospital charges ($41,730 vs $51,014, P < .001).
  
  
  CONCLUSIONS
  Cardiologists performing lower extremity angioplasty were more likely to treat patients with claudication than those with rest pain or gangrene/ulceration. Despite treating younger patients with less severe peripheral vascular disease, cardiologists used significantly greater hospital resources. High practitioner volume, regardless of specialty, was associated with lower hospital resource utilization. Reducing variations in indication and practitioner volume may offer substantial cost savings for lower extremity endovascular interventions.
authors.affiliation: Division of Vascular Surgery, The Surgical Outcomes Research Group, Robert Wood Johnson Medical School, The University of Medicine and Dentistry, New Brunswick, New Jersey 08903-0019, USA. vogelto@umdnj.edu
authors.forename: Todd R
authors.initials: TR
authors.lastname: Vogel
authors.forename: Viktor Y
authors.initials: VY
authors.lastname: Dombrovskiy
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Carson
authors.forename: Paul B
authors.initials: PB
authors.lastname: Haser
authors.forename: Alan M
authors.initials: AM
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000191:economics / Q000706:statistics & numerical data*; D002309:Cardiology / Q000191:economics; D002983:Clinical Competence; D017046:Cost Savings; D019992:Databases as Topic; D005260:Female; D005734:Gangrene; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs; D006801:Humans; D007383:Intermittent Claudication / Q000191:economics / Q000209:etiology / Q000628:therapy*; D007902:Length of Stay; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009515:New Jersey; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000191:economics / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000191:economics; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000191:economics; D055815:Young Adult