title: Comparison of Inhospital Outcomes and Hospitalization Costs of Peripheral Angioplasty and Endovascular Stenting.
abstract: The comparative data for angioplasty and stenting for treatment of peripheral arterial disease are largely limited to technical factors such as patency rates with sparse data on clinical outcomes like mortality, postprocedural complications, and amputation. The study cohort was derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2006 to 2011. Peripheral endovascular interventions were identified using appropriate International Classification of Diseases, Ninth Revision (ICD-9) Diagnostic and procedural codes. Two-level hierarchical multivariate mixed models were created. The primary outcome includes inhospital mortality, and secondary outcome was a composite of inhospital mortality and postprocedural complications. Amputation was a separate outcome. Hospitalization costs were also assessed. Endovascular stenting (odds ratio, 95% confidence interval, p value) was independently predictive of lower composite end point of inhospital mortality and postprocedural complications compared with angioplasty alone (0.96, 0.91 to 0.99, 0.025) and lower amputation rates (0.56, 0.53 to 0.60, <0.001) with no significant difference in terms of inhospital mortality alone. Multivariate analysis also revealed stenting to be predictive of higher hospitalization costs ($1,516, 95% confidence interval 1,082 to 1,950, p <0.001) compared with angioplasty. In conclusion, endovascular stenting is associated with a lower rate of postprocedural complications, lower amputation rates, and only minimal increase in hospitalization costs compared with angioplasty alone.
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.affiliation: Internal Medicine Department, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
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, Staten Island, New York.
authors.forename: Nileshkumar J
authors.initials: NJ
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, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Shantanu
authors.initials: S
authors.lastname: Solanki
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: 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 Health System, Youngstown, Ohio.
authors.forename: Samir V
authors.initials: SV
authors.lastname: Patel
authors.affiliation: Internal Medicine Department, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: Internal Medicine Department, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Cardiology Department, Mayo Clinic, Rochester, Minnesota.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Cardiology Department, Med Star Washington Hospital Center, Washington, DC.
authors.forename: Ankit
authors.initials: A
authors.lastname: Chothani
authors.affiliation: Internal Medicine Department, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Parth
authors.initials: P
authors.lastname: Bhatt
authors.affiliation: Internal Medicine Department, Prince George's Hospital Center, Cheverly, Maryland.
authors.forename: Ghanshyambhai T
authors.initials: GT
authors.lastname: Savani
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Jay
authors.initials: J
authors.lastname: Patel
authors.affiliation: Cardiology Department, Wright Center for Graduate Medical Education Program, Scranton, Pennsylvania.
authors.forename: Keyur
authors.initials: K
authors.lastname: Mavani
authors.affiliation: Internal Medicine Department, St. Vincent Charity Medical Centre, Cleveland, Ohio.
authors.forename: Ronak
authors.initials: R
authors.lastname: Bhimani
authors.affiliation: Internal Medicine Department, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
authors.forename: Byomesh
authors.initials: B
authors.lastname: Tripathi
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: Robert 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 I
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 K
authors.initials: JK
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; D017130:Angioplasty / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000191:economics / Q000401:mortality / Q000601:surgery*; D057216:Propensity Score; D015607:Stents / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult