Abstract 18620: Who Performs Endovascular Aortic Aneurysm Repair?
Introduction: Endovascular aortic aneurysm repair (EVAR) technology has realized significant advances, making it more readily available to a wider array of practitioners. We analyzed a statewide administrative dataset to define which types of practitioners perform EVAR procedures and examine specialty-specific outcomes.
Methods: Utilizing de-identified data from the Florida State Agency for Health Care Administration, we identified patients based on ICD-9 procedure codes who underwent EVAR between the years 2000-2014. We then assigned these procedures with the specialty of the operating physician and then analyzed outcomes based on the classification of the practitioner.
Results: There were 1,786 practitioners who completed 35,361 EVAR procedures during the study period. There was a statistically significant difference between the type of practitioner performing the surgery and the number of cases completed during the study period (P<.001). Figure 1 shows the proportions of practitioners performing EVAR with average cases logged by specialty. When comparing EVAR performed by vascular surgeons to those performed by non-vascular surgeons, patients had significantly shorter lengths of stay (P<.001), higher age-adjusted Charlson Comorbidity Index (CCI) scores (P=.003), lower associated procedural costs (P<.001), a higher proportion of Medicare and Veteran insurance (P<.001), and a higher likelihood of undergoing EVAR for “urgent” or “emergent” indication (P<.001) if treated by a vascular surgeon. No specialty-specific differences in mortality were identified. Generalized linear mixed models were performed to identify predictors for in-hospital mortality as well as disposition.
Conclusion: Performing more EVAR procedures than any other practitioner type, vascular surgeons treat a sicker and more urgent cohort of patients, have shorter lengths of stay, and have lower associated costs as compared to other practitioners performing EVAR.
Author Disclosures: A. Tanious: None. N. Karunathilake: None. J. Toro: None. A. Abu-Hanna: None. T.J. Fawcett: None. B. Graves: None. P.R. Nelson: None.
- © 2016 by American Heart Association, Inc.