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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Impact of Hospital Procedural Volume on Outcomes After Endovascular Revascularization for Critical Limb Ischemia
JACC: Cardiovascular Interventions, Volume 14, No. 17, Year 2021
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Description
Objectives: The aim of this study was to evaluate the interaction between hospital endovascular lower extremity revascularization (eLER) volume and outcomes after eLER for critical limb ischemia (CLI). Background: There is a paucity of data on the relationship between hospital procedural volume and outcomes of eLER for CLI. Methods: The authors queried the Nationwide Readmission Database (2013-2015) for hospitalized patients who underwent eLER for CLI. Hospitals were divided into tertiles according to annual eLER volume: low volume (<100 eLER procedures), moderate volume (100-550 eLER procedures), and high volume (>550 eLER procedures). Stepwise multivariable regression models were used. The main outcomes were in-hospital mortality and 30-day readmission with major adverse limb events, defined as the composite of amputation, acute limb ischemia, or repeat revascularization. Results: Among 145,785 hospitalizations for eLER for CLI, 5,199 (3.6%) were at low-volume eLER hospitals, 27,857 (19.1%) at moderate-volume eLER hospitals, and 112,728 (77.3%) at high-volume eLER hospitals. On multivariable analysis, there was no difference with regard to in-hospital mortality among moderate-volume hospitals (adjusted odds ratio [OR]: 0.78; 95% CI: 0.60-1.01) and high-volume hospitals (adjusted OR: 0.84; 95% CI: 0.64-1.05) compared with low-volume hospitals. There was lower risk of in-hospital major amputation (adjusted OR: 0.82; 95% CI: 0.70-0.96) and minor amputation at high- versus low-volume hospitals. The length of hospital stay was shorter and discharges to nursing facilities were fewer among moderate- and high-volume hospitals compared with low-volume hospitals. Compared with low-volume hospitals, eLER for CLI at high-volume hospitals had a lower risk for 30-day readmission with major adverse limb events (adjusted OR: 0.83; 95% CI: 0.70-0.99), while there was no difference among moderate-volume hospitals (adjusted OR: 0.92; 95% CI: 0.77-1.10). Conclusions: This nationwide observational analysis suggests that annual eLER volume does not influence in-hospital mortality after eLER for CLI. However, high eLER volume (>550 eLER procedures) was associated with better rates of limb preservation after eLER for CLI. © 2021
Authors & Co-Authors
Elbadawi, Ayman
United States, Houston
Baylor College of Medicine
Elgendy, Islam Y.
Qatar, Doha
Weill Cornell Medicine-qatar
Rai, Devesh
United States, Rochester
Rochester General Hospital
Megaly, Michael S.
United States, Phoenix
Banner - University Medical Center Phoenix
Pershad, Ashish
United States, Chandler
Chandler Regional Medical Center
Denktaş, Ali Emin Emin
United States, Houston
Baylor College of Medicine
Brilakis, Emmanouil S.
United States, Minneapolis
Abbott Northwestern Hospital
Drachman, Douglas E.
United States, Boston
Massachusetts General Hospital
Banerjee, Subhash
United States, Dallas
Ut Southwestern Medical Center
Shishehbor, Mehdi H.
United States, Cleveland
Case School of Medicine
Jneid, Hani M.
United States, Houston
Baylor College of Medicine
Statistics
Citations: 14
Authors: 11
Affiliations: 9
Identifiers
Doi:
10.1016/j.jcin.2021.06.032
ISSN:
19368798
Research Areas
Health System And Policy
Study Design
Case-Control Study