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The Comparative Effectiveness of Vascular Surgeons Over Interventionalists in Endovascular Repair of Abdominal Aortic Aneurysms
Brandon A McCutcheon*1, David C Chang*1, John Rose*1, Ralitza Parina*1, Logan Marcus*1, Dennis F. Bandyk1, Samuel E Wilson2, Mark A Talamini1
1UC San Diego School of Medicine, San Diego, CA;2UC Irvine School of Medicine, Irvine, CA

OBJECTIVE(S):
Multiple types of specialists perform interventional vascular procedures. Given differences in training, operative experience, and involvement in patient preoperative evaluation, the objective of this study was to quantify differences in patient outcomes between vascular surgeons and interventionalists (cardiologists and radiologists).
METHODS:
Analysis included patients with an ICD-9 procedure code of 39.71 indicating “endovascular implantation of graft for abdominal aorta” within the Nationwide Inpatient Sample from 1998-2009. Using unique surgeon identifiers, vascular surgeons were identified by previous experience with elective open AAA repair or arteriovenous (AV) fistula repair.
RESULTS:
28,094 patients received EVAR for AAA between 2001 and 2009. Procedural risk determined by the Charlson Index was similar (P=0.1263) for the treatment groups. Unadjusted mortality rates, lengths of stay, and total charges were significantly less for patients of vascular surgeons relative to interventionalists (Table 1). On multivariate analysis vascular surgeons were associated with a decreased likelihood of mortality (O.R., 0.75, 95% CI 0.60-0.93), cost ($7,702, 95% CI $5806-$9599), and length of stay (0.38 days 95% CI 0.18-0.58 days).
CONCLUSIONS:
Outcomes amongst patients receiving EVAR for AAA are better in terms of mortality, cost, and length of stay for those receiving care from a vascular surgeon compared to patients of an interventionalist. These data may have implications regarding health policy, training paradigms, and specialty certification/credentialing in the current era of health reform and comparative effectiveness.
TABLE 1. Summary of Unadjusted Patient Characteristics for Vascular Surgeons vs Interventionalists
Vascular Surgeon (n=22,299)Interventionalist (n=5,795)P-Value
Mortality Rate (%)1.83.4<0.001
Length of Stay, mean (median)3.6 (2)4.6 (2)<0.001
Mean (median) Charges, $100074.5 (62.8)89.0 (72.3)<0.001
Percent of Patients w/ Charlson Index >221.722.60.1263


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