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Fewer Vascular Surgery Training Opportunities Are Associated With Worse Lower Extremity Bypass Outcomes
Adham Abou Ali, Zeina Al Ghadban, Catherine Go, Andrew Lee, Frank Annie, Scott Dean, Mohammad Eslami.
camc, charleston, WV, USA.
OBJECTIVES: Lower extremity bypass (LEB) outcomes vary across U.S. regions in the Vascular Quality Initiative (VQI). One factor influencing these outcomes may be the distribution of vascular surgery training programs, impacting surgical expertise, resources, and patient care. This study evaluates the association between vascular surgery training position opportunities and LEB outcomes in the VQI.
METHODS: We analyzed the VQI LEB database (2003-2024) across nine regions, including patients with at least one year of follow-up. Each region was matched with its vascular surgery training position density per 1,000,000 population from the National Resident Matching Program. Baseline demographics, comorbidities, and operative characteristics were compared across regions. The primary outcomes were 1-year major amputation and major adverse limb event (MALE) rates, assessed via Kaplan-Meier survival analysis and multivariate logistic regression.
RESULTS: We identified 36,261 LEB procedures with 1-year follow-up. The South Atlantic region had the highest number of LEBs (10,758), followed by New England (9,103). The Mountain and Pacific regions had the lowest training density (0.16 and 0.38 positions per 1,000,000), while New England and Mid-Atlantic had the highest (1.12 and 1.06). The Mountain and Pacific regions had the oldest cohorts and the highest MALE rates at 1 year. The Mid-Atlantic and Mountain regions had the highest proportions of infrapopliteal targets at 48.5% and 45.0%. After adjusting for baseline demographic covariates, comorbidities, indications for bypass, graft target, and graft type, a unit increase in training position density is associated with a 42.4% reduction in the odds of major amputation at 1-year and an 8.8% reduction in MALE at 1-year. (P<.05).
CONCLUSIONS:Regional differences in vascular surgery training opportunities may be associated with differences in LEB outcomes. Regions with fewer training positions are associated with worse MALE outcomes.
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