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Outcomes of Percutaneous Lower Extremity Procedures Depend More on Indication than Physician Specialty
Justin R. Wallace, MD, Theodore H. Yuo, MD, Rabih A. Chaer, MD, Michel S. Makaroun, MD.
UPMC, Pittsburgh, PA, USA.

Objective: Outcomes of percutaneous lower extremity procedures (PLEP) have been recently linked to physician specialty. Unfortunately, the indication for intervention was not reported. We sought to compare outcomes between specialties performing PLEP for different indications, in a recent statewide inpatient discharge dataset.
Methods: The Florida hospital discharge data from 2005-2009 was reviewed for patients with PLEP during hospitalization. We assigned physician specialty as interventional radiology (IR), interventional cardiology (IC), or vascular surgery (VS) based on physician associated procedures. Clinical indication was claudication or critical limb ischemia (CLI). We limited our analysis to patients without concomitant open surgery during hospitalization. We compared mortality, length of stay (LOS), major use of ICU, discharge disposition, and total charges between specialties with logistic regression models, both unadjusted and adjusted for demographic and clinical characteristics.
Results: 15,398 patients (47% with CLI) had a PLEP. IC performed the majority of procedures on claudicants (VS 30%, IC 57%, IR 13%), while VS performed the majority of procedures on CLI patients (VS 50%, IC 22%, IR 27%). VS and IR were more likely than IC to treat CLI patients (VS 59%, IR 65%, IC 26%; P<.001). Among CLI patients, there was no difference in mortality rates between the three specialties in unadjusted analysis (VS 2.3%, IR 3.0%, IC 2.1%, P=.124), nor after adjustment (odds ratio [OR] VS: reference, IR: 1.05, IC: 0.82, P=NS for both). However, compared to VS, IR treated patients were less likely to be discharged home (OR: 0.73, P<.001), LOS was longer (β: 1.15 days, P<.001), major ICU use was more common (OR: 1.48, P<.001), and total charges were higher (β: $3,267, P=.001). CLI was most predictive for death (OR: 4.02, P<.001), major ICU use (OR: 1.95, P<.001), discharge home (OR: 0.50, P<.001), increased LOS (β: 3.25 days, P<.001), and total charges (β: $18,364, P<.001).
Conclusions: VS treat the majority of CLI patients, while IC treat mostly claudicants. Although physician specialty does impact several clinical outcomes the clinical indication for PLEP is the strongest predictor of adverse outcomes. Future outcome analyses of PLEP should adjust for clinical indication.


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