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Endovascular procedures associated with lower mortality, LOS, cost vs. surgical bypass: Results of Critical Limb Ischemia National Study

Posted in Peripheral Arterial Disease & Peripheral Vascular Surgery, tagged critical limb ischemia (CLI), endovascular procedures, Journal of the American College of Cardiology, mehdi shishehbor, peripheral artery disease (PAD) on March 23, 2016| Leave a Comment »

Endovascular procedures associated with lower mortality, LOS, cost vs. surgical bypass: Results of Critical Limb Ischemia National Study

Reporter: Aviva Lev-Ari, PhD, RN

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https://consultqd.clevelandclinic.org/2016/03/critical-limb-ischemia-national-snapshot-management-holds-surprises/?utm_campaign=qd+tweets&utm_medium=social&utm_source=twitter&utm_content=160322+critical+limb+ischemia+management&dynid=twitter-_-qd+tweets-_-social-_-social-_-160322+critical+limb+ischemia+management

Mar. 21, 2016 / Heart & Vascular / News & Insight

a new comprehensive analysis of a nationwide hospital sample of nearly 650,000 patients conducted from 2003 to 2011.

Mehdi Shishehbor, DO, MPH, PhD

“We found that rates of surgery for CLI are going down while rates of endovascular procedures are going up,” says Mehdi Shishehbor, DO, MPH, PhD, Director of Endovascular Services at Cleveland Clinic. “Meanwhile hospital admissions for CLI have remained constant even as rates of amputation and death from CLI have gone down. This suggests there’s something at work other than improved medical therapy for CLI.”

Dr. Shishehbor led the Cleveland Clinic-conducted analysis, which was just published in Journal of the American College of Cardiology and will also be presented at the 65th Annual Scientific Session of the American College of Cardiology (ACC.16) in Chicago in early April.

Key findings

The researchers’ key findings are reflected in the figure below and include the following:

Figure. Nationwide trends in CLI hospital admissions and outcomes over time, based on the analysis by Shishehbor and colleagues. Reprinted from Agarwal S, Sud K, Shishehbor MH, J Am Coll Cardiol. 2016 Mar 21 [Epub ahead of print], ©2016, with permission from the American College of Cardiology Foundation.

The annual rate of CLI admissions remained relatively constant (at ~150/100,000 population) throughout the 2003-2011 period despite a progressive increase in the rate of admissions for PAD. “The rise in PAD might be secondary to the rise in prevalence of cardiovascular risk factors, which we observed,” notes Dr. Shishehbor. “An increase in the rate of PAD-related admissions, with the constant rate of CLI-related admissions, might suggest early detection of PAD, leading to improved PAD management and the relative stabilization of CLI rates.”
The proportion of patients with CLI undergoing surgical revascularization declined significantly during the study period (from 13.9 percent in 2003 to 8.8 percent in 2011) while the proportion undergoing endovascular treatment rose significantly (from 5.1 percent to 11.0 percent).
There was a steady and significant decline in rates of in-hospital death and major amputation across the study period among patients with CLI as well as a significant overall decline in mean length of stay. Despite these improvements, mean hospitalization cost remained unchanged throughout the study period.
Compared with surgical revascularization, endovascular treatment of CLI was associated with significantly lower in-hospital mortality, mean LOS and mean hospitalization cost — even after adjustment for potential confounders — despite statistically comparable rates of major amputation.

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