Lower-extremity endovascular interventions for Medicare beneficiaries: comparative effectiveness as a function of provider specialty.
OBJECTIVE
Lower-extremity endovascular interventions are increasingly being performed by vascular surgeons (VSs) and interventional cardiologists (ICs) in addition to interventional radiologists (IRs). Regardless of specialty, well trained, experienced, and dedicated operators are expected to offer the best outcomes. To examine specialty-specific trends, outcomes of percutaneous lower-extremity revascularizations in Medicare beneficiaries were compared according to physician specialty types providing the service.


METHODS
Medicare Standard Analytical Files that contain longitudinal data of all services (physician, inpatient, outpatient) provided to a 5% sample of Medicare beneficiaries were studied. All claims for percutaneous angioplasty, atherectomy, and stent implantation of lower-extremity arteries during the years 2005–2007 were extracted, and the following outcomes were assessed: mortality, transfusion, intensive care unit (ICU) use, length of stay, and subsequent revascularization or amputation. Outcomes were compared by using regression models adjusted for age, sex, race, emergency department admission, and comorbid conditions.


RESULTS
Most outcomes were significantly worse if the service was provided by vascular surgeons compared with other vascular specialists. The in-hospital mortality rate for procedures performed by VSs was 19% higher than for those performed by others, but this difference was not significant (P =.351). Adjusted average 1-year procedure costs were significantly lower for IRs ($17,640) than for VSs ($19,012) or ICs ($19,096).


CONCLUSIONS
Medicare data show that endovascular lower-extremity revascularization by vascular surgeons results in more transfusion and ICU use, longer hospital stay, more repeat revascularization procedures or amputations, and higher costs compared with procedures performed by interventional radiologists.
Vascular Disease Research Center, Rhode Island Hospital, Department of Diagnostic Imaging, Alpert MedicalSchool, Brown University, Providence, RI 02903, USA.
Abdul M
AM
Zafar
Rajoo
R
Dhangana
Timothy P
TP
Murphy
Scott C
SC
Goodwin
Richard
R
Duszak
Charles E
CE
Ray
Nikolay E
NE
Manolov
D000368:Aged; D000369:Aged, 80 and over; D057186:Comparative Effectiveness Research; D039702:Current Procedural Terminology; D057510:Endovascular Procedures / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D006278:Medicare; D008511:Medicine; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D016491:Peripheral Vascular Diseases / Q000401:mortality / Q000628:therapy*; D015641:Radiography, Interventional; D012044:Regression Analysis; D014481:United States