Effect of physician and hospital experience on patient outcomes for endovascular treatment of aortoiliac occlusive disease

Jeffrey E. Indes, Charles T. Tuggle, Anant Mandawat, Bart E. Muhs, Julie A. Sosa

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Objective: To evaluate the effect of physician volume and specialty and hospital volume on population-level outcomes after endovascular repair of aortoiliac occlusive disease (AIOD). Design: A retrospective cross-sectional analysis of all inpatients undergoing endovascular repair of AIOD. Physician volume was classified as low (<17 procedures per year [<50th percentile]) or high (≤17 procedures per year). Physicians were defined as surgeons if they performed at least 1 carotid, aortic, or iliac endarterectomy; open aortic repair; above- or below-knee amputation; or aortoiliac-femoral bypass. Hospital volume was low (<116 procedures per year [<50th percentile]) or high (≥116 procedures per year). Patients: Eight hundred eighteen inpatients who underwent endovascular repair of AIOD in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from January 2003 through December 2007. Setting: National hospital database. Main Outcome Measures: In-hospital complications and mortality, length of stay, and cost. Results: Of the 818 procedures, 59.0% of high-volume physicians were surgeons and 65.0% practiced at high-volume hospitals. Unadjusted complication rates were significantly higher for low-volume compared with highvolume physicians (18.7% vs 12.6%; P=.02); rates were not significantly different by physician specialty (P=.88) or hospital volume (P=.16). Shorter length of stay was associated with high-volume physicians (P=.001), highvolume hospitals (P=.001), and surgeon providers (P=.03), whereas decreased cost was associated with physician specialty (P=.004). On multivariate analysis, high physician volume was associated with significantly lower complications (P=.04); high hospital volume, with shorter length of stay (P=.002); and nonsurgeons, with higher costs (P=.05). Conclusions: Overall, volume at the physician and hospital levels appears to be a robust predictor of patient outcomes after endovascular interventions for AIOD. Surgeons performing endovascular procedures for AIOD have a decreased associated hospital cost compared with nonsurgeons.

Original languageEnglish (US)
Pages (from-to)966-971
Number of pages6
JournalArchives of Surgery
Volume146
Issue number8
DOIs
StatePublished - Aug 2011
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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