title: Intravascular Ultrasound in Lower Extremity Peripheral Vascular Interventions: Variation in Utilization and Impact on In-Hospital Outcomes From the Nationwide Inpatient Sample (2006-2011).
abstract: OBJECTIVE
  To examine the impact of intravascular ultrasound (IVUS) utilization during lower limb endovascular interventions as regards postprocedural complications and amputation.
  
  
  METHODS
  The study cohort was derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database between the years 2006 and 2011. Peripheral endovascular interventions were identified using appropriate ICD-9 procedure codes. Two-level hierarchical multivariate mixed models were created. The co-primary outcomes were in-hospital mortality and amputation; the secondary outcome was postprocedural complications. Model results are given as the odds ratio (OR) and 95% confidence interval (CI). Hospitalization costs were also assessed.
  
  
  RESULTS
  Overall, among the 92,714 patients extracted from the database during the observation period, IVUS was used in 1299 (1.4%) patients. IVUS utilization during lower extremity peripheral vascular procedures was independently predictive of a lower rate of postprocedural complications (OR 0.80, 95% CI 0.66 to 0.99, p=0.037) as well as lower amputation rates (OR 0.59, 95% CI 0.45 to 0.77, p<0.001) without any significant impact on in-hospital mortality. Multivariate analysis also revealed IVUS utilization to be predictive of a nonsignificant increase in hospitalization costs ($1333, 95% CI -$167 to +$2833, p=0.082).
  
  
  CONCLUSIONS
  IVUS use during lower limb endovascular interventions is predictive of lower postprocedural complication and amputation rates with a nonsignificant increase in hospitalization costs.
authors.affiliation: Borgess Medical Centre, Kalamazoo, MI, USA.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.affiliation: Mount Sinai St. Luke's Roosevelt Hospital, New York, NY, USA.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Saint Peter's University Hospital, New Brunswick, NJ, USA.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: New York Medical College, Valhalla, NY, USA.
authors.forename: Chirag
authors.initials: C
authors.lastname: Savani
authors.affiliation: Icahn School of Public Health at Mount Sinai, New York, NY, USA.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Western Reserve Health System, Youngstown, OH, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Patel
authors.affiliation: University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
authors.forename: Nish
authors.initials: N
authors.lastname: Patel
authors.affiliation: Saint Peter's University Hospital, New Brunswick, NJ, USA.
authors.forename: Kanishk
authors.initials: K
authors.lastname: Agnihotri
authors.affiliation: Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
authors.forename: Parth
authors.initials: P
authors.lastname: Bhatt
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Borgess Medical Centre, Kalamazoo, MI, USA.
authors.forename: Vishal
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Yale School of Medicine, New Haven, CT, USA.
authors.forename: Ramak R
authors.initials: RR
authors.lastname: Attaran
authors.affiliation: Yale School of Medicine, New Haven, CT, USA.
authors.forename: Carlos I
authors.initials: CI
authors.lastname: Mena
authors.affiliation: Detroit Medical Center, Detroit, MI, USA.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
authors.affiliation: Yale School of Medicine, New Haven, CT, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Cleman
authors.affiliation: Yale School of Medicine, New Haven, CT, USA.
authors.forename: John K
authors.initials: JK
authors.lastname: Forrest
authors.affiliation: The Everett Clinic, Everett, WA, USA apurva_badheka@yahoo.com.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D023821:Limb Salvage; D016014:Linear Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000191:economics; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
keywords: amputation; angioplasty; complications; cost analysis; intravascular ultrasound; mortality; peripheral vascular interventions; resource utilization; stents; ultrasound