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

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.