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Trends in Percutaneous Renal Artery Intervention in the South
Thomas D. Conlee, MD1, Jason W. Christie, MD1, Jeanette S. Andrews, MS2, Matthew S. Edwards, MD1, Kimberely J. Hansen, MD1.
1Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA, 2Wake Forest University Medical School, Winston-Salem, NC, USA.

Objective: To examine trends in renal artery (RA) percutaneous balloon angioplasty and stenting (PTAS) in the South.
Methods: Hospital discharge data from the Nationwide Inpatient Sample (NIS) were used to examine the rate of percutaneous intervention of renal arteries in the South region for the years 2001-2005. The NIS is the largest all-payer inpatient care database in the United States that samples approximately 20% of hospitalized patients across the country and can be analyzed regionally. The database includes ICD-9 CM codes for procedures and diagnoses during hospitalizations. These codes were used to estimate trends in RA-PTAS. PTAS was classified as either therapeutic or prophylactic based on the presence or absence of hypertension and/or renal insufficiency. Associations across years were evaluated using logistic regression. All analyses employed methods appropriate for complex survey data.
Results: During the five year study period, over 100,000 patients underwent RA-PTAS in the South. This group consisted of 51.3 percent female, 31.6 percent non-white, with a mean age of 65.1 years. The annual estimated rate of RA-PTAS (see Table 1) ranged between 28,385 (2001) and 34,382 (2004), and represented 0.20-0.23 percent of all hospitalizations (p=0.33). Overall, from 2001 to 2005, there was a significant decrease in the proportion of prophylactic PTAS (from 26.5% in 2001 to 22.4% in 2005; P=0.03). Compared to 2001, the proportion of prophylactic PTAS, compared with therapeutic PTAS, decreased significantly in 2004 (OR=0.84; 95% CI: 0.73-0.96; P=0.01) and in 2005 (OR=0.80; 95% CI: 0.67-0.96; P=0.02).
Table 1. Annual Number of RA-PTAS Procedures in the South.
Total
Procedures
Therapeutic
Procedures
YearOverall Number of RA-PTAS Procedures Performed (SD)Percent of Hospitalizations (SE)Number of Therapeutic Procedures
(SD)
Percent of Total Procedures
(SE)
200128,385 (2,133)0.20 (0.01)20,869 (1,620)73.5 (1.40)
200231,570 (2,502)0.22 (0.02)13,917 (1,960)75.8 (1.05)
200330,471 (2,133)0.21 (0.01)22,883 (1,589)75.1 (0.81)
200434,382 (2,345)0.23 (0.01)26,425 (1,882)76.9 (1.23)
200530,457 (2,484)0.20 (0.01)23,635 (1,965)77.6 (1.06)

Conclusions: Over a recent 5 year period, estimates of RA-PTAS performed annually in the South ranged from 28,385 to 34,382 procedures. Approximately one-fourth of these procedures appear to be prophylactic, performed in the absence of hypertension and/or renal dysfunction. The proportion of prophylactic procedures decreased during this study period.


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