Peripheral arterial disease (PAD) patients who are treated by interventional radiologists may see lower in-hospital mortality and shorter hospital stays compared with those treated by vascular surgeons, according to a study published in the January issue of the Journal of Vascular and Interventional Radiology. Patients treated by interventional cardiologists saw better outcomes than vascular surgeons.
“Lower-extremity endovascular interventions are increasingly being performed by vascular surgeons (VSs) and interventional cardiologists (ICs) in addition to interventional radiologists (IRs),” Abdul M. Zafar, MD, from Rhode Island Hospital in Providence, R.I., and colleagues wrote. “Regardless of specialty, well-trained, experienced and dedicated operators are expected to offer the best outcomes.”
To examine the outcomes of lower-extremity revascularizations among Medicare beneficiaries, Zafar and colleagues used the Medicare Standard Analytical Files to view claims for percutanous angioplasty, atherectomy and stent implantation of the lower extremities between 2005 and 2007. The researchers analyzed data from a total of 14,608 patients. Of these patients, 3,565 index procedures were performed by IRs, 5,489 by ICs, 5,358 by VSs and 196 by other specialists.
Researchers assessed length of stay, mortality, transfusion, ICU use and subsequent revascularization procedures. The researchers reported that patients treated by VSs were worse off in terms of service and outcomes compared with patients who were treated by IRs or ICs. They found that the in-hospital mortality rate was 19 percent higher for procedures performed by VSs compared with those performed by other specialists; however, the difference was not significant, they wrote.
After adjustments, the researchers found one-year procedure costs to be significantly lower for IRs compared with VSs, $17,640 vs. $19,012, respectively. One-year procedural costs for ICs were reported to be $19,096.
Additionally, IRs had a 32 percent lower likelihood of ICU use and a 37 percent lower likelihood of repeat revascularization or amputation when compared with VSs. Patients treated by VSs also were the only patients who saw a post-index procedure length of stay that exceeded three days.
“The reasons for worse outcomes among VSs are not known, but may be related to insufficient training in catheter-based interventions or dilution of experience as a result of the extensive time learning and practicing open surgical procedures compared with IRs and ICs, whose focus is catheter-based interventions,” the authors wrote.
An important finding of the study was that procedures performed by IRs saved Medicare patients an average of $1,372 compared to those performed by VSs. The savings were an average of $1,456 when a procedure was performed by a VS compared with a procedure performed by an IC.
“Although we did not develop predictive models, if these observations are correct, extrapolating these findings to the more than 183,534 ELER [endovascular lower extremity revascularization] procedures performed in Medicare beneficiaries in year 2006 shows potential savings of $210 million for Medicare in the year 2006 alone, had all the specialists matched the cost efficiency of the lowest-cost provider,” the authors wrote.
“As baby boomers enter the Medicare population in an era of economic turmoil, cost effectiveness will be increasingly important,” the authors concluded.
“The questions that these data raise are whether patients’ or payors’ interests are served by the practice model of a single specialty providing both endovascular and open revascularization services, or whether outcomes are better and costs lower when these services are provided by different specialties.”