Main SCVS Site
Annual Meeting Home
Final Program
Past & Future Meetings
 

Back to 2015 Annual Symposium Program


Impact of Physician Specialty and Operator Experience upon Outcomes Following EVAR
Ahahita Dua, MD, Justin Safarik, Rehana Satani, James Pan, MD, Douglas Hood, MD, Kim J. Hodgson, MD, Sapan S. Desai, MD, PhD, MBA.
Southern Illinois University, Springfield, IL, USA.

Objectives: Endovascular aneurysm repair (EVAR) is commonly performed by interventional radiologists, cardiologists, general surgeons, cardiothoracic surgeons, and vascular surgeons, with each specialty having differences in residency structure, operative experience, and subspecialty training. The aim of this study is to evaluate the impact of surgeon specialty on outcomes following EVAR.
Methods: Patients who underwent EVAR were identified from the 2007-2009 Nationwide Inpatient Sample (NIS). Physician identifiers in the NIS were used to determine surgical specialty and operative experience. Multivariate analysis adjusted for mortality risk was used to compare differences in demographics, complications, outcomes, and hospital covariates.
Results: A total of 5,147 EVARs were identified within the NIS, of which 88.3% were completed by vascular surgeons. There were no significant differences in demographics between the specialties. Cardiothoracic surgeons were more likely to have a postoperative stroke (3.1% vs. 0.2%, OR 14.6, 95% CI 1.8-117.8, P<0.05) and cardiac complications (9.4% vs. 2.0%, OR 5.0, 95% CI 1.5-16.6, P<0.01) compared to other specialties. Vascular surgeons were somewhat more likely to have postoperative respiratory complications (0.7% vs. 0.0%, P<0.05). Overall costs were lowest for vascular surgeons ($32,094), and highest for cardiothoracic surgeons ($41,663, P<0.05). Postoperative mortality was highest for general surgeons (7.4% vs. 2.5%, OR 3.2, 95% CI 1.1-8.9, P<0.05). Only vascular surgeons completed more than 10 EVARs per year.
Discussion: Physician specialty and operative experience impacts patient outcome following EVAR. Low volume surgeons have a higher rate of complications, cost, and mortality, but this was not the case for interventional cardiologists or radiologists. These findings may impact patient referral patterns and hospital privileges for providers.
Table I. Patient characteristics by specialty.
VariableInterventional RadiologistInterventional CardiologistGeneral SurgeonCardiothoracic SurgeonVascular Surgeon
Demographics
Total cases373 (7.2%)141 (2.7%)54 (1.0%)32 (0.6%)4,547 (88.3%)
Age73.6 +/- 10.473.4 +/- 9.173.9 +/- 11.467.1 +/- 11.773.7 +/- 8.7
Female gender19.8%17.7%22.2%18.8%18.6%
Elective79.9%82.9%74.1%75.0%82.7%
DRG mortality risk1.8 +/- 0.91.9 +/- 0.92.9 +/- 1.2^1.9 +/- 1.11.8 +/- 0.9
DRG severity of illness1.9 +/- 0.91.9 +/- 0.82.9 +/- 0.9^1.9 +/- 1.01.9 +/- 0.8
Complications
Bleeding4.6%2.8%1.9%3.1%3.5%
Stroke0.3%0.0%0.0%3.1%^0.2%
Cardiac1.6%1.4%0.0%9.4%^2.0%
Respiratory0.0%0.0%0.0%0.0%0.7%*
Vascular0.3%0.7%0.0%3.1%1.0%
SSI0.3%0.0%0.0%0.0%0.4%
Other1.3%0.0%0.0%0.0%0.7%
Outcomes
Length of stay (days)4.0 +/- 4.93.2 +/- 3.54.5 +/- 10.65.4 +/- 7.03.7 +/- 7.1
Costs$38,667#$33,599$33,274$41,663*$32,094#
Mortality1.3%0.7%7.4%*6.3%2.5%
Hospital Covariates
Urban location93.4%96.9%100%100%95.1%
Teaching hospital38.0%#40.6%71.4%73.3%58.4%#

* P<0.05; ^ P<0.01, # P<0.001.
Table II. Mortality risk-adjusted multivariate analysis of practitioner specialty and outcomes following EVAR.
VariableInterventional RadiologistInterventional CardiologistGeneral SurgeonCardiothoracic SurgeonVascular Surgeon
ORCIPORCIPORCIPORCIPORCIP
Bleeding1.320.79-2.20N.S.0.810.29-2.21N.S.0.520.072-3.79N.S.0.890.12-6.56N.S.Reference
Stroke1.220.16-9.55N.S.N/AN/A14.641.82-117.83<0.05Reference
Cardiac0.780.34-1.80N.S.0.690.17-2.83N.S.N/A4.951.48-16.55<0.01Reference
RespiratoryN/AN/AN/AN/AReference
Vascular0.280.038-2.00N.S.0.730.10-5.34N.S.N/A3.300.44-24.72N.S.Reference
SSI0.760.10-5.76N.S.N/AN/AN/AReference
Other1.920.74-4.95N.S.N/AN/AN/AReference
Death0.540.22-1.33N.S.0.280.040-2.04N.S.3.171.13-8.92<0.052.640.62-11.18N.S.Reference

Table III. Impact of volume on EVAR outcomes by physician specialty.
VariableInterventional RadiologistInterventional CardiologistGeneral SurgeonCardiothoracic SurgeonVascular Surgeon
VolumeLow volumeLow volumeLow volumeLow volumeLow volumeHigh volume
Bleeding4.6%2.8%1.9%3.1%3.7%2.9%
Stroke0.3%0.0%0.0%3.1%0.3%0.1%
Cardiac1.6%1.4%0.0%9.4%2.0%2.1%
Respiratory0.0%0.0%0.0%0.0%0.6%0.1%
Vascular0.3%0.7%0.0%3.1%1.0%0.7%
SSI0.3%0.0%0.0%0.0%0.4%0.1%
Other1.3%0.0%0.0%0.0%0.8%0.5%
Length of stay (days)4.0 +/- 4.93.2 +/- 3.54.5 +/- 10.65.4 +/- 7.03.8 +/- 7.63.5 +/- 2.0
Costs$32,858$33,599$33,274$25,801$32,130$31,950
Mortality1.3%0.7%7.4%6.3%2.4%2.7%


Back to 2015 Annual Symposium Program
 
© 2024 Society for Clinical Vascular Surgery . All Rights Reserved. Privacy Policy.