title: Transcatheter arterial revascularization outcomes at vascular and general surgery teaching hospitals and nonteaching hospitals are comparable.
abstract: BACKGROUND
  Outcomes following transcatheter interventions at vascular and general surgery teaching hospitals (STH) are unknown. We examine whether surgery training programs influence clinically relevant outcomes after commonly performed endovascular procedures.
  
  
  METHODS
  Using an all-payer inpatient care database from 2008, we selected adults who underwent either endovascular carotid stenting, endografting of descending thoracic aortic aneurysm, endovascular abdominal aortic aneurysm repair, or peripheral arterial revascularization. Patients were stratified by procedures completed at Surgery Teaching (Participate in Accreditation Council for Graduate Medical Education [ACGME]-accredited vascular and general surgery programs), STH, or nonteaching hospitals (NTH). Hierarchical regression models assessed adverse outcomes and in-hospital mortality among groups.
  
  
  RESULTS
  Of the 175,698 records, 44% of the patients were treated at STH, while 56% underwent procedures at NTH. The adjusted odds ratio of any complication or mortality at STH and NTH were similar. Transfers, weekend admissions, and nonelective cases were higher at STH (P < .001, respectively). Paradoxically, STH treated fewer patients with more than three comorbidities compared with NTH (STH: 47% vs NTH: 53%; P < .001). Surgical teaching status did not lower the adjusted odds of mortality for any procedure. Moreover, the occurrence of any complication (adjusted odds ratios, 0.9; 95% confidence interval, .82-1.14; P = .69) and mortality (adjusted odds ratios, 0.9; 95% confidence interval, .74-1.22; P = .67) were equivalent between vascular and general STH.
  
  
  CONCLUSIONS
  Following commonly performed transcatheter vascular procedures, and despite more transfers, weekend admissions, and nonelective procedures completed at STH, complications, and mortality were comparable across centers.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, USA.
authors.forename: Castigliano M
authors.initials: CM
authors.lastname: Bhamidipati
authors.forename: Damien J
authors.initials: DJ
authors.lastname: LaPar
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lutz
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Tracci
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Cherry
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Upchurch
authors.forename: John A
authors.initials: JA
authors.lastname: Kern
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D002404:Catheterization / Q000592:standards*; D016009:Chi-Square Distribution; D004503:Education, Medical, Graduate; D005260:Female; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D017063:Outcome Assessment, Health Care; D016491:Peripheral Vascular Diseases / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000401:mortality / Q000592:standards*