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Current Use and Outcomes of Ambulatory Vascular Surgery for Lower Extremity Ischemia
David E. Timaran, MD, Eric B. Rosero, MD, Adriana J. Higuera, MD, R James Valentine, MD, Carlos H. Timaran, MD.
University of Texas Southwestern Medical Center, Dallas, TX, USA.
Objective: The proliferation of endovascular procedures and changes in payment arrangements have increased the number of vascular procedures performed on an ambulatory basis. The purpose of this study was to evaluate the use and outcomes of ambulatory vascular surgery among patients with lower extremity (LE) ischemia in the United States (U.S.).
Methods: The National Survey of Ambulatory Surgery, a nationally representative database on ambulatory surgery procedures in the U.S., was used to identify vascular procedures performed for patients with LE ischemia in 2006. Logistic regression and general linear models were used to assess the association between patient characteristics, type of procedures and adverse outcomes.
Results: The estimated number of ambulatory procedures for LE ischemia was 333,842. Only 9.684 (2.9%) patients underwent vascular procedures for limb-threatening ischemia (LTI). Angiography was performed in 69.4% of patients. Most procedures (54.6%) were exclusively diagnostic, whereas 6% involved open and 36.8% endovascular revascularization, respectively. Postoperatively, 3.7% of patients reported adverse events, 3.2% were admitted to a hospital and 2.5% were discharged to observation status. Mean procedural time (in minutes) was significantly increased in women (50.5±36.2 vs. 31.8±36.5), procedures under general anesthesia (64.4±45.8 vs. 40.5±31.1), patients with LTI (80.4±16.5 vs. 45.6±36.6), endovascular procedures (60.9±42 vs. 36.9±29.1) and high-risk patients (49.4±29.2 vs. 44.5±29.2) (all P < .001). Multivariate logistic regression identified female gender, LTI, high surgical risk, use of general anesthesia, endovascular procedures, and procedural time as independent predictors of complications and increased odds of hospital admission.
Conclusions: Ambulatory vascular surgery is performed safely and with minimal periprocedural morbidity and hospital admission rates. Approximately half of the ambulatory vascular procedures involve exclusively diagnostic angiography, whereas more than one third include endovascular revascularization. Female gender, LTI, high surgical risk, general anesthesia and endovascular procedures are associated with an increased risk of complications, hospital admissions and procedural times.
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