title: Impact of Hospital Volume on Outcomes of Lower Extremity Endovascular Interventions (Insights from the Nationwide Inpatient Sample [2006 to 2011]).
abstract: Our primary objective was to study postprocedural outcomes and hospitalization costs after peripheral endovascular interventions and the multivariate predictors affecting the outcomes with emphasis on hospital volume. The study cohort was derived from Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (2006 to 2011). Peripheral endovascular interventions were identified using appropriate International Classification of Diseases, Ninth Revision diagnostic and procedural codes. Annual institutional volumes were calculated using unique identification numbers and then divided into quartiles. Two-level hierarchical multivariate mixed models were created. The primary outcome was inhospital mortality; secondary outcome was a composite of inhospital mortality and postprocedural complications. Amputation rates and hospitalization costs were also assessed. Multivariate analysis (odds ratio, 95% confidence interval, p value) revealed age (1.46, 1.37 to 1.55, p <0.001), female gender (1.28, 1.12 to 1.46, p <0.001), baseline co-morbidity status as depicted by a greater Charlson co-morbidity index score (≥2: 4.32, 3.45 to 5.40, p <0.001), emergent or urgent admissions(2.48, 2.14 to 2.88, p <0.001), and weekend admissions (1.53, 1.26 to 1.86, p <0.001) to be significant predictors of primary outcome. An increasing hospital volume quartile was independently predictive of improved primary (0.65, 0.52 to 0.82, p <0.001 for the fourth quartile) and secondary (0.85, 0.73 to 0.97, 0.02 for the fourth quartile) outcomes and lower amputation rates (0.52, 0.45 to 0.61, p <0.001). A significant reduction hospitalization costs ($-3,889, -5,318 to -2,459, p <0.001) was also seen in high volume centers. In conclusion, a greater hospital procedural volume is associated with superior outcomes after peripheral endovascular interventions in terms of inhospital mortality, complications, and hospitalization costs.
authors.affiliation: Internal Medicine Department, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New York.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.affiliation: Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: Internal Medicine Department, Staten Island University Hospital, New York, New York.
authors.forename: Nileshkumar
authors.initials: N
authors.lastname: Patel
authors.affiliation: Internal Medicine Department, Jersey City Medical Center, Jersey City, New Jersey.
authors.forename: Sopan
authors.initials: S
authors.lastname: Lahewala
authors.affiliation: Internal Medicine Department, New York Medical College at Westchester Medical Center, Valhalla, New York.
authors.forename: Shantanu
authors.initials: S
authors.lastname: Solanki
authors.affiliation: Internal Medicine Department, Drexel School of Public Health, Philadelphia, Pennsylvania.
authors.forename: Parshva
authors.initials: P
authors.lastname: Patel
authors.affiliation: Internal Medicine Department, Icahn School of Public Health at Mt. Sinai, New York, New York.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Sohilkumar
authors.initials: S
authors.lastname: Manvar
authors.affiliation: Internal Medicine Department, New York Medical College, Valhalla, New York.
authors.forename: Chirag
authors.initials: C
authors.lastname: Savani
authors.affiliation: Internal Medicine Department, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New York.
authors.forename: Byomesh
authors.initials: B
authors.lastname: Tripathi
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Sunny
authors.initials: S
authors.lastname: Jhamnani
authors.affiliation: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Internal Medicine Department, Western Reserve University, Youngstown, Ohio.
authors.forename: Samir
authors.initials: S
authors.lastname: Patel
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Jay
authors.initials: J
authors.lastname: Patel
authors.affiliation: Internal Medicine Department, St. Vincent Charity Medical Center, Cleveland, Ohio.
authors.forename: Ronak
authors.initials: R
authors.lastname: Bhimani
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Tamam
authors.initials: T
authors.lastname: Mohamad
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Remetz
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Ramak R
authors.initials: RR
authors.lastname: Attaran
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Cindy
authors.initials: C
authors.lastname: Grines
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Carlos Ignacio
authors.initials: CI
authors.lastname: Mena
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Michael
authors.initials: M
authors.lastname: Cleman
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors.forename: John
authors.initials: J
authors.lastname: Forrest
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut. Electronic address: apurva.badheka@yale.edu.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000639:trends; D017052:Hospital Mortality / Q000639:trends; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000191:economics / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D011184:Postoperative Period; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult