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Supplemental Digital Content Endovascular vs. Open Revascularization for Peripheral Arterial DiseaseTable of ContentsPageTable 1S: Diagnosis and procedural codes for inclusion into cohort2Table 2S: Subsequent intervention procedural codes5Table 3S: Subsequent interventions after endovascular and open lower extremity revascularization for matched groups8Table 4S: Adjusted hazard ratios and 95% confidence intervals for overall 4-year amputation or death, endovascular vs. open revascularization, controlling for patient demographics, preoperative characteristics, and perioperative factors9Table 5S: Adjusted hazard ratios and 95% confidence intervals for overall 4-year amputation or death, endovascular vs. open revascularization, by controlling for patient demographics, preoperative characteristics, and perioperative factors, stratified by propensity score quintiles10Figure 1S. Overall 4-year amputation free survival by endovascular vs. open revascularization and comorbidity in propensity score matched cohorts11References12List of Investigators:Jason T. Wiseman MD MSPH; Sara Fernandes-Taylor PhD; Sandeep Saha MS; Jeffrey Havlena MS; Paul J. Rathouz PhD; Maureen A. Smith MD PhD; and K. Craig Kent MDTable 1S: Diagnosis and procedural codes for inclusion into cohortDiagnosis codesClaudication*ICD-9 codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2012.12.031", "ISSN" : "1097-6809", "PMID" : "23541547", "abstract" : "OBJECTIVE: As pressure to contain health care costs increases, there has been greater scrutiny of readmissions in the vascular surgery population. The objective of this study was to evaluate postoperative readmissions after open and endovascular lower extremity (LE) procedures for peripheral artery disease (PAD).\n\nMETHODS: A retrospective cohort study was performed of elective adult inpatients with PAD and LE procedures which were selected from the Health Facts database (Cerner Corporation, Kansas City, Mo) between October 2008 and December 2010 using International Classification of Disease, 9th Clinical Modification diagnosis codes (claudication, rest pain, and ulceration/gangrene) and procedure codes for LE revascularization (endovascular and open). Multivariable logistic regression and \u03c7(2) were used to compare patients who received endovascular and open procedures. The Charlson Comorbidity Index, comorbid diagnoses, and laboratory results were used to adjust for confounding. The main outcome measure evaluated was readmission \u2264 30 days of discharge.\n\nRESULTS: Of 463,362 index admissions, 16,574 patients were identified with a diagnosis of PAD. Combining PAD with elective LE procedures during the index admission, 777 underwent open and 681 underwent endovascular procedures. Unadjusted readmission rates for open and endovascular procedures for claudication, rest pain, and ulceration/gangrene were 10.2% vs 11.3% (P = .69), 14.0% vs 18.2% (P = .43), and 21.1% vs 19.5% (P = .69), respectively. Readmission increased by the severity of the diagnosis for open and endovascular procedures (P = .0006). Men comprised 58% of the cohort; readmission rates were not statistically different by sex (P = .19). Race was not associated with procedure performed (P = .16), but nonwhite race was associated with more severe PAD (P < .0001). After adjusting for race, sex, comorbidities, length of stay, and laboratory values outside of normal reference ranges, the association between an endovascular procedure and readmission was not statistically significant (odds ratio, 1.28; 95% confidence interval, 0.94-1.75).\n\nCONCLUSIONS: Less invasive endovascular procedures were not associated with decreased readmission rates compared with open surgery. The overall readmission rate for claudicant patients was 10.7%, which was unexpectedly high. Predictors of readmission included male sex, longer hospital stays, hospital infection, elevated aspartate aminotransferase, and high numbers of\u2026", "author" : [ { "dropping-particle" : "", "family" : "Vogel", "given" : "Todd R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kruse", "given" : "Robin L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2013", "7" ] ] }, "page" : "90-7.e1-4", "publisher" : "Society for Vascular Surgery", "title" : "Risk factors for readmission after lower extremity procedures for peripheral artery disease.", "type" : "article-journal", "volume" : "58" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jvs.2011.02.035", "ISSN" : "1097-6809", "PMID" : "21571495", "abstract" : "OBJECTIVE: Black patients with peripheral arterial disease undergo amputation at two to four times the rate of white patients. In order to determine whether differences in attempts at limb salvage might contribute to this disparity, we studied the limb care received prior to amputation by black patients compared with whites.\n\nMETHODS: Using inpatient Medicare data for the years 2003 through 2006, we identified a retrospective sample of all beneficiaries who underwent major lower extremity amputation. \"Limb salvage care\" was defined as limb-related admissions and procedures that occurred during the 2 years prior to amputation. We used multiple logistic regression to compare rates of revascularization and other limb care received by black versus white amputees, adjusting for individual patient characteristics. We then controlled for hospital referral region in order to assess whether differences in care might be attributable to the geographic regions in which black and white patients received care. Finally, we examined the timing of revascularization relative to amputation for both races.\n\nRESULTS: Our sample included 24,600 black and 65,881 white amputees. Compared with whites, black amputees were more likely to be female and had lower socioeconomic status. Average age, rates of diabetes, and levels of comorbidity were similar between races. Black amputees were significantly less likely than whites to have undergone revascularization (23.6% vs 31.6%; P < .0001), any limb-related admission (39.6% vs 44.7%; P < .0001), toe amputation (12.9% vs 13.8%; P < .0005), or wound debridement (11.6% vs 14.2%; P < .0001) prior to amputation. After adjusting for differences in individual patient characteristics, black amputees remained significantly less likely than whites to undergo revascularization (odds ratios [OR], 0.72 [95% confidence interval, .68-.76]), limb-related admission (OR, 0.81 [0.78-0.84]), or wound debridement prior to amputation (OR, 0.80 [0.75-0.85]). Timing of revascularization relative to amputation was similar between races. Observed differences in care were shown to exist within hospital referral regions and were not accounted for by regional differences in where black and white patients received care.\n\nCONCLUSION: Black patients are much less likely than whites to undergo attempts at limb salvage prior to amputation. Further studies should explore whether this disparity might be attributable to race-related differences in severity of arterial \u2026", "author" : [ { "dropping-particle" : "", "family" : "Holman", "given" : "Kerianne H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henke", "given" : "Peter K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dimick", "given" : "Justin B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Birkmeyer", "given" : "John D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "2011", "8" ] ] }, "page" : "420-6, 426.e1", "publisher" : "Elsevier Inc.", "title" : "Racial disparities in the use of revascularization before leg amputation in Medicare patients.", "type" : "article-journal", "volume" : "54" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^1,2", "plainTextFormattedCitation" : "1,2", "previouslyFormattedCitation" : "(1,2)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1,2:440.21 Atherosclerosis of native arteries of the extremities with intermittent claudication Critical limb ischemiaICD-9 codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2012.12.031", "ISSN" : "1097-6809", "PMID" : "23541547", "abstract" : "OBJECTIVE: As pressure to contain health care costs increases, there has been greater scrutiny of readmissions in the vascular surgery population. The objective of this study was to evaluate postoperative readmissions after open and endovascular lower extremity (LE) procedures for peripheral artery disease (PAD).\n\nMETHODS: A retrospective cohort study was performed of elective adult inpatients with PAD and LE procedures which were selected from the Health Facts database (Cerner Corporation, Kansas City, Mo) between October 2008 and December 2010 using International Classification of Disease, 9th Clinical Modification diagnosis codes (claudication, rest pain, and ulceration/gangrene) and procedure codes for LE revascularization (endovascular and open). Multivariable logistic regression and \u03c7(2) were used to compare patients who received endovascular and open procedures. The Charlson Comorbidity Index, comorbid diagnoses, and laboratory results were used to adjust for confounding. The main outcome measure evaluated was readmission \u2264 30 days of discharge.\n\nRESULTS: Of 463,362 index admissions, 16,574 patients were identified with a diagnosis of PAD. Combining PAD with elective LE procedures during the index admission, 777 underwent open and 681 underwent endovascular procedures. Unadjusted readmission rates for open and endovascular procedures for claudication, rest pain, and ulceration/gangrene were 10.2% vs 11.3% (P = .69), 14.0% vs 18.2% (P = .43), and 21.1% vs 19.5% (P = .69), respectively. Readmission increased by the severity of the diagnosis for open and endovascular procedures (P = .0006). Men comprised 58% of the cohort; readmission rates were not statistically different by sex (P = .19). Race was not associated with procedure performed (P = .16), but nonwhite race was associated with more severe PAD (P < .0001). After adjusting for race, sex, comorbidities, length of stay, and laboratory values outside of normal reference ranges, the association between an endovascular procedure and readmission was not statistically significant (odds ratio, 1.28; 95% confidence interval, 0.94-1.75).\n\nCONCLUSIONS: Less invasive endovascular procedures were not associated with decreased readmission rates compared with open surgery. The overall readmission rate for claudicant patients was 10.7%, which was unexpectedly high. Predictors of readmission included male sex, longer hospital stays, hospital infection, elevated aspartate aminotransferase, and high numbers of\u2026", "author" : [ { "dropping-particle" : "", "family" : "Vogel", "given" : "Todd R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kruse", "given" : "Robin L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2013", "7" ] ] }, "page" : "90-7.e1-4", "publisher" : "Society for Vascular Surgery", "title" : "Risk factors for readmission after lower extremity procedures for peripheral artery disease.", "type" : "article-journal", "volume" : "58" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jvs.2011.02.035", "ISSN" : "1097-6809", "PMID" : "21571495", "abstract" : "OBJECTIVE: Black patients with peripheral arterial disease undergo amputation at two to four times the rate of white patients. In order to determine whether differences in attempts at limb salvage might contribute to this disparity, we studied the limb care received prior to amputation by black patients compared with whites.\n\nMETHODS: Using inpatient Medicare data for the years 2003 through 2006, we identified a retrospective sample of all beneficiaries who underwent major lower extremity amputation. \"Limb salvage care\" was defined as limb-related admissions and procedures that occurred during the 2 years prior to amputation. We used multiple logistic regression to compare rates of revascularization and other limb care received by black versus white amputees, adjusting for individual patient characteristics. We then controlled for hospital referral region in order to assess whether differences in care might be attributable to the geographic regions in which black and white patients received care. Finally, we examined the timing of revascularization relative to amputation for both races.\n\nRESULTS: Our sample included 24,600 black and 65,881 white amputees. Compared with whites, black amputees were more likely to be female and had lower socioeconomic status. Average age, rates of diabetes, and levels of comorbidity were similar between races. Black amputees were significantly less likely than whites to have undergone revascularization (23.6% vs 31.6%; P < .0001), any limb-related admission (39.6% vs 44.7%; P < .0001), toe amputation (12.9% vs 13.8%; P < .0005), or wound debridement (11.6% vs 14.2%; P < .0001) prior to amputation. After adjusting for differences in individual patient characteristics, black amputees remained significantly less likely than whites to undergo revascularization (odds ratios [OR], 0.72 [95% confidence interval, .68-.76]), limb-related admission (OR, 0.81 [0.78-0.84]), or wound debridement prior to amputation (OR, 0.80 [0.75-0.85]). Timing of revascularization relative to amputation was similar between races. Observed differences in care were shown to exist within hospital referral regions and were not accounted for by regional differences in where black and white patients received care.\n\nCONCLUSION: Black patients are much less likely than whites to undergo attempts at limb salvage prior to amputation. Further studies should explore whether this disparity might be attributable to race-related differences in severity of arterial \u2026", "author" : [ { "dropping-particle" : "", "family" : "Holman", "given" : "Kerianne H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henke", "given" : "Peter K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dimick", "given" : "Justin B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Birkmeyer", "given" : "John D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "2011", "8" ] ] }, "page" : "420-6, 426.e1", "publisher" : "Elsevier Inc.", "title" : "Racial disparities in the use of revascularization before leg amputation in Medicare patients.", "type" : "article-journal", "volume" : "54" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^1,2", "plainTextFormattedCitation" : "1,2", "previouslyFormattedCitation" : "(1,2)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1,2:440.20 Atherosclerosis of native arteries of the extremities, unspecified 440.22 Atherosclerosis of native arteries of the extremities with rest pain 440.23 Atherosclerosis of native arteries of the extremities with ulceration440.24 Atherosclerosis of native arteries of the extremities with gangrene785.4 Gangrene 440.29 Other atherosclerosis of native arteries of the extremities 440.4 Chronic total occlusion of artery of the extremities 443.9 Unspecified peripheral vascular disease 707.10Ulcer unspecified 707.11Ulcer of thigh 707.12Ulcer of calf 707.13Ulcer of the ankle 707.14Ulcer of heel/foot 707.15Ulcer of foot/toes 707.19Ulcer of other part of lower limb 730.06Acute osteomyelitis, lower leg730.07Acute osteomyelitis, ankle and foot730.16Chronic osteomyelitis, lower leg730.17Chronic osteomyelitis, ankle and foot730.26Unspecified osteomyelitis, lower leg730.27Unspecified osteomyelitis, ankle and foot730.36Periostitis, without mention of osteomyelitis, lower leg730.37Periostitis, without mention of osteomyelitis, ankle and foot730.86Other infections involving bone in diseases classified elsewhere, lower leg730.87Other infections involving bone in diseases classified elsewhere, ankle and foot730.96Unspecified infection of bone, lower leg730.97Unspecified infection of bone, ankle and footProcedural codesEndovascularICD-9 codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2012.12.031", "ISSN" : "1097-6809", "PMID" : "23541547", "abstract" : "OBJECTIVE: As pressure to contain health care costs increases, there has been greater scrutiny of readmissions in the vascular surgery population. The objective of this study was to evaluate postoperative readmissions after open and endovascular lower extremity (LE) procedures for peripheral artery disease (PAD).\n\nMETHODS: A retrospective cohort study was performed of elective adult inpatients with PAD and LE procedures which were selected from the Health Facts database (Cerner Corporation, Kansas City, Mo) between October 2008 and December 2010 using International Classification of Disease, 9th Clinical Modification diagnosis codes (claudication, rest pain, and ulceration/gangrene) and procedure codes for LE revascularization (endovascular and open). Multivariable logistic regression and \u03c7(2) were used to compare patients who received endovascular and open procedures. The Charlson Comorbidity Index, comorbid diagnoses, and laboratory results were used to adjust for confounding. The main outcome measure evaluated was readmission \u2264 30 days of discharge.\n\nRESULTS: Of 463,362 index admissions, 16,574 patients were identified with a diagnosis of PAD. Combining PAD with elective LE procedures during the index admission, 777 underwent open and 681 underwent endovascular procedures. Unadjusted readmission rates for open and endovascular procedures for claudication, rest pain, and ulceration/gangrene were 10.2% vs 11.3% (P = .69), 14.0% vs 18.2% (P = .43), and 21.1% vs 19.5% (P = .69), respectively. Readmission increased by the severity of the diagnosis for open and endovascular procedures (P = .0006). Men comprised 58% of the cohort; readmission rates were not statistically different by sex (P = .19). Race was not associated with procedure performed (P = .16), but nonwhite race was associated with more severe PAD (P < .0001). After adjusting for race, sex, comorbidities, length of stay, and laboratory values outside of normal reference ranges, the association between an endovascular procedure and readmission was not statistically significant (odds ratio, 1.28; 95% confidence interval, 0.94-1.75).\n\nCONCLUSIONS: Less invasive endovascular procedures were not associated with decreased readmission rates compared with open surgery. The overall readmission rate for claudicant patients was 10.7%, which was unexpectedly high. Predictors of readmission included male sex, longer hospital stays, hospital infection, elevated aspartate aminotransferase, and high numbers of\u2026", "author" : [ { "dropping-particle" : "", "family" : "Vogel", "given" : "Todd R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kruse", "given" : "Robin L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2013", "7" ] ] }, "page" : "90-7.e1-4", "publisher" : "Society for Vascular Surgery", "title" : "Risk factors for readmission after lower extremity procedures for peripheral artery disease.", "type" : "article-journal", "volume" : "58" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jvs.2011.02.035", "ISSN" : "1097-6809", "PMID" : "21571495", "abstract" : "OBJECTIVE: Black patients with peripheral arterial disease undergo amputation at two to four times the rate of white patients. In order to determine whether differences in attempts at limb salvage might contribute to this disparity, we studied the limb care received prior to amputation by black patients compared with whites.\n\nMETHODS: Using inpatient Medicare data for the years 2003 through 2006, we identified a retrospective sample of all beneficiaries who underwent major lower extremity amputation. \"Limb salvage care\" was defined as limb-related admissions and procedures that occurred during the 2 years prior to amputation. We used multiple logistic regression to compare rates of revascularization and other limb care received by black versus white amputees, adjusting for individual patient characteristics. We then controlled for hospital referral region in order to assess whether differences in care might be attributable to the geographic regions in which black and white patients received care. Finally, we examined the timing of revascularization relative to amputation for both races.\n\nRESULTS: Our sample included 24,600 black and 65,881 white amputees. Compared with whites, black amputees were more likely to be female and had lower socioeconomic status. Average age, rates of diabetes, and levels of comorbidity were similar between races. Black amputees were significantly less likely than whites to have undergone revascularization (23.6% vs 31.6%; P < .0001), any limb-related admission (39.6% vs 44.7%; P < .0001), toe amputation (12.9% vs 13.8%; P < .0005), or wound debridement (11.6% vs 14.2%; P < .0001) prior to amputation. After adjusting for differences in individual patient characteristics, black amputees remained significantly less likely than whites to undergo revascularization (odds ratios [OR], 0.72 [95% confidence interval, .68-.76]), limb-related admission (OR, 0.81 [0.78-0.84]), or wound debridement prior to amputation (OR, 0.80 [0.75-0.85]). Timing of revascularization relative to amputation was similar between races. Observed differences in care were shown to exist within hospital referral regions and were not accounted for by regional differences in where black and white patients received care.\n\nCONCLUSION: Black patients are much less likely than whites to undergo attempts at limb salvage prior to amputation. Further studies should explore whether this disparity might be attributable to race-related differences in severity of arterial \u2026", "author" : [ { "dropping-particle" : "", "family" : "Holman", "given" : "Kerianne H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henke", "given" : "Peter K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dimick", "given" : "Justin B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Birkmeyer", "given" : "John D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "2011", "8" ] ] }, "page" : "420-6, 426.e1", "publisher" : "Elsevier Inc.", "title" : "Racial disparities in the use of revascularization before leg amputation in Medicare patients.", "type" : "article-journal", "volume" : "54" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^1,2", "plainTextFormattedCitation" : "1,2", "previouslyFormattedCitation" : "(1,2)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1,2:39.50 Angioplasty of other noncoronary vessel(s)39.79 Other endo procedures of other vessels 39.90 Insertion of nondrug-eluting peripheral vessel stents(s) 00.55 Insertion of drug-eluting non-coronary stentCPT codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2009.01.035", "ISSN" : "1097-6809", "PMID" : "19481407", "abstract" : "INTRODUCTION: Advances in endovascular interventions have expanded the options available for the invasive treatment of lower extremity peripheral arterial disease (PAD). Whether endovascular interventions substitute for conventional bypass surgery or are simply additive has not been investigated, and their effect on amputation rates is unknown.\n\nMETHODS: We sought to analyze trends in lower extremity endovascular interventions (angioplasty and atherectomy), lower extremity bypass surgery, and major amputation (above and below-knee) in Medicare beneficiaries between 1996 and 2006. We used 100% samples of Medicare Part B claims to calculate annual procedure rates of lower extremity bypass surgery, endovascular interventions (angioplasty and atherectomy), and major amputation between 1996 and 2006. Using physician specialty identifiers, we also examined trends in the specialty performing the primary procedure.\n\nRESULTS: Between 1996 and 2006, the rate of major lower extremity amputation declined significantly (263 to 188 per 100,000; risk ratio [RR] 0.71, 95% confidence interval [CI] 0.6-0.8). Endovascular interventions increased more than threefold (from 138 to 455 per 100,000; RR = 3.30; 95% CI: 2.9-3.7) while bypass surgery decreased by 42% (219 to 126 per 100,000; RR = 0.58; 95% CI: 0.5-0.7). The increase in endovascular interventions consisted both of a growth in peripheral angioplasty (from 135 to 337 procedures per 100,000; RR = 2.49; 95% CI: 2.2-2.8) and the advent of percutaneous atherectomy (from 3 to 118 per 100,000; RR = 43.12; 95% CI: 34.8-52.0). While radiologists performed the majority of endovascular interventions in 1996, more than 80% were performed by cardiologists and vascular surgeons by 2006. Overall, the total number of all lower extremity vascular procedures almost doubled over the decade (from 357 to 581 per 100,000; RR = 1.63; 95% CI: 1.5-1.8).\n\nCONCLUSION: Endovascular interventions are now performed much more commonly than bypass surgery in the treatment of lower extremity PAD. These changes far exceed simple substitution, as more than three additional endovascular interventions were performed for every one procedure declined in lower extremity bypass surgery. During this same time period, major lower extremity amputation rates have fallen by more than 25%. However, further study is needed before any causal link can be established between lower extremity vascular procedures and improved rates of limb salvage in patients with PAD.", "author" : [ { "dropping-particle" : "", "family" : "Goodney", "given" : "Philip P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beck", "given" : "Adam W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nagle", "given" : "Jan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Welch", "given" : "H Gilbert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zwolak", "given" : "Robert M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009", "7" ] ] }, "page" : "54-60", "publisher" : "The Society for Vascular Surgery", "title" : "National trends in lower extremity bypass surgery, endovascular interventions, and major amputations.", "type" : "article-journal", "volume" : "50" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jvs.2012.11.068.Regional", "author" : [ { "dropping-particle" : "", "family" : "Goodney", "given" : "Philip P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holman", "given" : "Kerianne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henke", "given" : "Peter K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lori", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dimick", "given" : "Justin B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stukel", "given" : "Therese A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fisher", "given" : "Elliott S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Birkmeyer", "given" : "John D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-2", "issue" : "6", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "1471-1480", "title" : "Regional intensity of vascular care and lower extremity amputation rates", "type" : "article-journal", "volume" : "57" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^3,4", "plainTextFormattedCitation" : "3,4", "previouslyFormattedCitation" : "(3,4)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3,4:35454Transluminal balloon angioplasty, open; iliac35473Transluminal balloon angioplasty, percutaneous; iliac35456Transluminal balloon angioplasty, open; femoral-popliteal35459Transluminal balloon angioplasty, open; tibioperoneal trunk and branches35470Transluminal balloon angioplasty, percutaneous; tibioperoneal trunk or branches, each vessel35474Transluminal balloon angioplasty, percutaneous; femoral-popliteal37205Transcatheter placement of an intravascular stent(s), (except coronary, carotid, and vertebral vessel), percutaneous; initial vessel37206Transcatheter placement of an intravascular stent(s), (except coronary, carotid, and vertebral vessel), percutaneous; each additional vessel 37207Transcatheter placement of an intravascular stent(s), (noncoronary vessel), open; initial vessel 37208Transcatheter placement of an intravascular stent(s), (noncoronary vessel), open; each additional vessel35482Transluminal peripheral atherectomy, open; iliac35492Transluminal peripheral atherectomy, percutaneous; iliac35483Transluminal peripheral atherectomy, open; femoral-popliteal35485Transluminal peripheral atherectomy, open; tibioperoneal trunk and branches35493Transluminal peripheral atherectomy, percutaneous; femoral-popliteal35495Transluminal peripheral atherectomy, percutaneous; tibioperoneal trunk and branchesOpenICD-9 codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2012.12.031", "ISSN" : "1097-6809", "PMID" : "23541547", "abstract" : "OBJECTIVE: As pressure to contain health care costs increases, there has been greater scrutiny of readmissions in the vascular surgery population. The objective of this study was to evaluate postoperative readmissions after open and endovascular lower extremity (LE) procedures for peripheral artery disease (PAD). METHODS: A retrospective cohort study was performed of elective adult inpatients with PAD and LE procedures which were selected from the Health Facts database (Cerner Corporation, Kansas City, Mo) between October 2008 and December 2010 using International Classification of Disease, 9th Clinical Modification diagnosis codes (claudication, rest pain, and ulceration/gangrene) and procedure codes for LE revascularization (endovascular and open). Multivariable logistic regression and \u03c7(2) were used to compare patients who received endovascular and open procedures. The Charlson Comorbidity Index, comorbid diagnoses, and laboratory results were used to adjust for confounding. The main outcome measure evaluated was readmission \u2264 30 days of discharge. RESULTS: Of 463,362 index admissions, 16,574 patients were identified with a diagnosis of PAD. Combining PAD with elective LE procedures during the index admission, 777 underwent open and 681 underwent endovascular procedures. Unadjusted readmission rates for open and endovascular procedures for claudication, rest pain, and ulceration/gangrene were 10.2% vs 11.3% (P = .69), 14.0% vs 18.2% (P = .43), and 21.1% vs 19.5% (P = .69), respectively. Readmission increased by the severity of the diagnosis for open and endovascular procedures (P = .0006). Men comprised 58% of the cohort; readmission rates were not statistically different by sex (P = .19). Race was not associated with procedure performed (P = .16), but nonwhite race was associated with more severe PAD (P < .0001). After adjusting for race, sex, comorbidities, length of stay, and laboratory values outside of normal reference ranges, the association between an endovascular procedure and readmission was not statistically significant (odds ratio, 1.28; 95% confidence interval, 0.94-1.75). CONCLUSIONS: Less invasive endovascular procedures were not associated with decreased readmission rates compared with open surgery. The overall readmission rate for claudicant patients was 10.7%, which was unexpectedly high. Predictors of readmission included male sex, longer hospital stays, hospital infection, elevated aspartate aminotransferase, and high numbers of me\u2026", "author" : [ { "dropping-particle" : "", "family" : "Vogel", "given" : "Todd R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kruse", "given" : "Robin L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2013", "7" ] ] }, "page" : "90\u201397.e4", "publisher" : "Society for Vascular Surgery", "title" : "Risk Factors for Readmission after Lower Extremity Procedures for Peripheral Artery Disease.", "type" : "article-journal", "volume" : "58" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jvs.2011.02.035", "ISSN" : "1097-6809", "PMID" : "21571495", "abstract" : "OBJECTIVE: Black patients with peripheral arterial disease undergo amputation at two to four times the rate of white patients. In order to determine whether differences in attempts at limb salvage might contribute to this disparity, we studied the limb care received prior to amputation by black patients compared with whites.\n\nMETHODS: Using inpatient Medicare data for the years 2003 through 2006, we identified a retrospective sample of all beneficiaries who underwent major lower extremity amputation. \"Limb salvage care\" was defined as limb-related admissions and procedures that occurred during the 2 years prior to amputation. We used multiple logistic regression to compare rates of revascularization and other limb care received by black versus white amputees, adjusting for individual patient characteristics. We then controlled for hospital referral region in order to assess whether differences in care might be attributable to the geographic regions in which black and white patients received care. Finally, we examined the timing of revascularization relative to amputation for both races.\n\nRESULTS: Our sample included 24,600 black and 65,881 white amputees. Compared with whites, black amputees were more likely to be female and had lower socioeconomic status. Average age, rates of diabetes, and levels of comorbidity were similar between races. Black amputees were significantly less likely than whites to have undergone revascularization (23.6% vs 31.6%; P < .0001), any limb-related admission (39.6% vs 44.7%; P < .0001), toe amputation (12.9% vs 13.8%; P < .0005), or wound debridement (11.6% vs 14.2%; P < .0001) prior to amputation. After adjusting for differences in individual patient characteristics, black amputees remained significantly less likely than whites to undergo revascularization (odds ratios [OR], 0.72 [95% confidence interval, .68-.76]), limb-related admission (OR, 0.81 [0.78-0.84]), or wound debridement prior to amputation (OR, 0.80 [0.75-0.85]). Timing of revascularization relative to amputation was similar between races. Observed differences in care were shown to exist within hospital referral regions and were not accounted for by regional differences in where black and white patients received care.\n\nCONCLUSION: Black patients are much less likely than whites to undergo attempts at limb salvage prior to amputation. Further studies should explore whether this disparity might be attributable to race-related differences in severity of arterial \u2026", "author" : [ { "dropping-particle" : "", "family" : "Holman", "given" : "Kerianne H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henke", "given" : "Peter K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dimick", "given" : "Justin B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Birkmeyer", "given" : "John D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "2011", "8" ] ] }, "page" : "420-6, 426.e1", "publisher" : "Elsevier Inc.", "title" : "Racial disparities in the use of revascularization before leg amputation in Medicare patients.", "type" : "article-journal", "volume" : "54" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^2,5", "plainTextFormattedCitation" : "2,5", "previouslyFormattedCitation" : "(2,5)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }2,5:38.08 Incision of lower limb arteries 38.18 Endarterectomy of lower limb arteries 38.38 Resection of lower limb arteries with anastomosis 38.48 Resection of lower limb arteries with replacement 39.29 Other (peripheral) vascular shunt or bypass 39.56 Repair of blood vessel with tissue patch graft 39.57 Repair of blood vessel with synthetic patch graft 39.58 Repair of blood vessel with unspecified type of patch graft 39.59 Other repair of vessel CPT codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2012.11.068.Regional", "author" : [ { "dropping-particle" : "", "family" : "Goodney", "given" : "Philip P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holman", "given" : "Kerianne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henke", "given" : "Peter K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lori", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dimick", "given" : "Justin B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stukel", "given" : "Therese A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fisher", "given" : "Elliott S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Birkmeyer", "given" : "John D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "1471-1480", "title" : "Regional intensity of vascular care and lower extremity amputation rates", "type" : "article-journal", "volume" : "57" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "(4)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4:35563Bypass graft, with vein; ilioiliac 35565Bypass graft, with vein; iliofemoral 35661Bypass graft, with other than vein; femoral-femoral 35663Bypass graft, with other than vein; ilioiliac35665Bypass graft, with other than vein; iliofemoral 35556Bypass graft, with vein; femoral-popliteal 35558Bypass graft, with vein; femoral-femoral35566Bypass graft, with vein; femoral-anterior tibial, posterior tibial, peroneal artery 35571Bypass graft, with vein; popliteal-tibial, -peroneal artery or other distal vessels 35583In-situ vein bypass; femoral-popliteal 35585In-situ vein bypass; femoral-anterior tibial, posterior tibial, or peroneal artery 35587In-situ vein bypass; popliteal-tibial, peroneal 35656Bypass graft, with other than vein; femoral-popliteal 35666Bypass graft, with other than vein; femoral-anterior tibial, posterior tibial, or peroneal artery 35671Bypass graft, with other than vein; popliteal-tibial or -peroneal artery 35879Revision, lower extremity arterial bypass, without thrombectomy, open; with vein patch angioplasty35881Revision, lower extremity arterial bypass, without thrombectomy, open; with segmental vein interposition 35883Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with nonautogenous patch graft35884Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with autogenous vein patch graft 35541Bypass graft, with vein35681Bypass graft; composite, prosthetic and vein 35682Bypass graft; autogenous composite, two segments of veins from two locations 35683Bypass graft; autogenous composite, three or more segments of vein35351Thromboendarterectomy, including patch graft, if performed; iliac 35355Thromboendarterectomy, including patch graft, if performed; iliofemoral35302Thromboendarterectomy, including patch graft, if performed; superficial femoral artery35303Thromboendarterectomy, including patch graft, if performed; popliteal artery 35304Thromboendarterectomy, including patch graft, if performed; tibioperoneal trunk artery35305Thromboendarterectomy, including patch graft, if performed; tibial or peroneal artery 35306Thromboendarterectomy, including patch graft, if performed; each additional tibial 35371Thromboendarterectomy, including patch graft, if performed; common femoral 35372Thromboendarterectomy, including patch graft, if performed; deep (profunda) femoral*Patients were classified as having claudication, and not critical limb ischemia, if they had a ICD-9 diagnosis code of 440.21 without co-diagnosis of rest pain, osteomyelitis, ulceration, and/or gangrene.Table 2S: Subsequent intervention procedural codesAll additional interventionsEndovascular reinterventionsAngioplastyICD-9 codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2012.12.031", "ISSN" : "1097-6809", "PMID" : "23541547", "abstract" : "OBJECTIVE: As pressure to contain health care costs increases, there has been greater scrutiny of readmissions in the vascular surgery population. The objective of this study was to evaluate postoperative readmissions after open and endovascular lower extremity (LE) procedures for peripheral artery disease (PAD).\n\nMETHODS: A retrospective cohort study was performed of elective adult inpatients with PAD and LE procedures which were selected from the Health Facts database (Cerner Corporation, Kansas City, Mo) between October 2008 and December 2010 using International Classification of Disease, 9th Clinical Modification diagnosis codes (claudication, rest pain, and ulceration/gangrene) and procedure codes for LE revascularization (endovascular and open). Multivariable logistic regression and \u03c7(2) were used to compare patients who received endovascular and open procedures. The Charlson Comorbidity Index, comorbid diagnoses, and laboratory results were used to adjust for confounding. The main outcome measure evaluated was readmission \u2264 30 days of discharge.\n\nRESULTS: Of 463,362 index admissions, 16,574 patients were identified with a diagnosis of PAD. Combining PAD with elective LE procedures during the index admission, 777 underwent open and 681 underwent endovascular procedures. Unadjusted readmission rates for open and endovascular procedures for claudication, rest pain, and ulceration/gangrene were 10.2% vs 11.3% (P = .69), 14.0% vs 18.2% (P = .43), and 21.1% vs 19.5% (P = .69), respectively. Readmission increased by the severity of the diagnosis for open and endovascular procedures (P = .0006). Men comprised 58% of the cohort; readmission rates were not statistically different by sex (P = .19). Race was not associated with procedure performed (P = .16), but nonwhite race was associated with more severe PAD (P < .0001). After adjusting for race, sex, comorbidities, length of stay, and laboratory values outside of normal reference ranges, the association between an endovascular procedure and readmission was not statistically significant (odds ratio, 1.28; 95% confidence interval, 0.94-1.75).\n\nCONCLUSIONS: Less invasive endovascular procedures were not associated with decreased readmission rates compared with open surgery. The overall readmission rate for claudicant patients was 10.7%, which was unexpectedly high. Predictors of readmission included male sex, longer hospital stays, hospital infection, elevated aspartate aminotransferase, and high numbers of\u2026", "author" : [ { "dropping-particle" : "", "family" : "Vogel", "given" : "Todd R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kruse", "given" : "Robin L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2013", "7" ] ] }, "page" : "90-7.e1-4", "publisher" : "Society for Vascular Surgery", "title" : "Risk factors for readmission after lower extremity procedures for peripheral artery disease.", "type" : "article-journal", "volume" : "58" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹", "plainTextFormattedCitation" : "1", "previouslyFormattedCitation" : "(1)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1: 39.50 Angioplasty of other noncoronary vessel(s)CPT codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2009.01.035", "ISSN" : "1097-6809", "PMID" : "19481407", "abstract" : "INTRODUCTION: Advances in endovascular interventions have expanded the options available for the invasive treatment of lower extremity peripheral arterial disease (PAD). Whether endovascular interventions substitute for conventional bypass surgery or are simply additive has not been investigated, and their effect on amputation rates is unknown.\n\nMETHODS: We sought to analyze trends in lower extremity endovascular interventions (angioplasty and atherectomy), lower extremity bypass surgery, and major amputation (above and below-knee) in Medicare beneficiaries between 1996 and 2006. We used 100% samples of Medicare Part B claims to calculate annual procedure rates of lower extremity bypass surgery, endovascular interventions (angioplasty and atherectomy), and major amputation between 1996 and 2006. Using physician specialty identifiers, we also examined trends in the specialty performing the primary procedure.\n\nRESULTS: Between 1996 and 2006, the rate of major lower extremity amputation declined significantly (263 to 188 per 100,000; risk ratio [RR] 0.71, 95% confidence interval [CI] 0.6-0.8). Endovascular interventions increased more than threefold (from 138 to 455 per 100,000; RR = 3.30; 95% CI: 2.9-3.7) while bypass surgery decreased by 42% (219 to 126 per 100,000; RR = 0.58; 95% CI: 0.5-0.7). The increase in endovascular interventions consisted both of a growth in peripheral angioplasty (from 135 to 337 procedures per 100,000; RR = 2.49; 95% CI: 2.2-2.8) and the advent of percutaneous atherectomy (from 3 to 118 per 100,000; RR = 43.12; 95% CI: 34.8-52.0). While radiologists performed the majority of endovascular interventions in 1996, more than 80% were performed by cardiologists and vascular surgeons by 2006. Overall, the total number of all lower extremity vascular procedures almost doubled over the decade (from 357 to 581 per 100,000; RR = 1.63; 95% CI: 1.5-1.8).\n\nCONCLUSION: Endovascular interventions are now performed much more commonly than bypass surgery in the treatment of lower extremity PAD. These changes far exceed simple substitution, as more than three additional endovascular interventions were performed for every one procedure declined in lower extremity bypass surgery. During this same time period, major lower extremity amputation rates have fallen by more than 25%. However, further study is needed before any causal link can be established between lower extremity vascular procedures and improved rates of limb salvage in patients with PAD.", "author" : [ { "dropping-particle" : "", "family" : "Goodney", "given" : "Philip P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beck", "given" : "Adam W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nagle", "given" : "Jan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Welch", "given" : "H Gilbert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zwolak", "given" : "Robert M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009", "7" ] ] }, "page" : "54-60", "publisher" : "The Society for Vascular Surgery", "title" : "National trends in lower extremity bypass surgery, endovascular interventions, and major amputations.", "type" : "article-journal", "volume" : "50" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³", "plainTextFormattedCitation" : "3", "previouslyFormattedCitation" : "(3)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3:35454Transluminal balloon angioplasty, open; iliac35473Transluminal balloon angioplasty, percutaneous; iliac35456Transluminal balloon angioplasty, open; femoral-popliteal35459Transluminal balloon angioplasty, open; tibioperoneal trunk and branches35470Transluminal balloon angioplasty, percutaneous; tibioperoneal trunk or branches, each vessel35474Transluminal balloon angioplasty, percutaneous; femoral-poplitealThrombolysisCPT codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2010.12.055", "ISSN" : "1097-6809", "PMID" : "21397441", "abstract" : "OBJECTIVES: Catheter-based revascularization has emerged as an alternative to surgical bypass for the tibioperoneal vessels. The purpose of this analysis was to describe the outcomes of tibial angioplasty interventions for critical limb ischemia (CLI) in the hospitalized Medicare population, to examine in-hospital complications, to define the 30-day readmission and mortality rates, and to assess secondary procedures performed in this population.\n\nMETHODS: In-patients with CLI undergoing tibioperoneal angioplasty were identified using The Centers for Medicare & Medicaid Services in-patient claims for 2005 to 2007. In-hospital complications, mortality, 30-day secondary procedures, and 30-day rehospitalization after discharge were described.\n\nRESULTS: A total of 13,258 in-patients underwent tibioperoneal angioplasty (54.2% men; 75.7% white, 17.1% African American; 42.8% gangrene, 46.7% rest pain, 10.5% claudication) and 29.3% had a stent, 47.3% had femoral-popliteal angioplasty, and 20.1% had atherectomy during their initial procedure. Initial hospital complications included renal complications (8.1%), respiratory complications and pneumonia (5.1%), and cardiac complications with acute myocardial infarction (3.2%). Mortality in-hospital was 2.8% and at 30 days was 6.7%. Thirty-day rehospitalization rate was 29.6%. Thirty-day reinterventions included repeat angiogram (8.5%), repeat tibioperoneal angioplasty (3.2%), open bypass (2.1%), and lower extremity amputations (23.8%). Gangrene was the most frequent diagnosis at rehospitalization (13.5%). Patients with gangrene as an indication for tibioperoneal angioplasty were 1.8 times (95% confidence interval [CI], 1.56-2.10) as likely as patients with rest pain to be rehospitalized during 30 days after discharge. Among comorbidities, predictors of 30-day rehospitalization included chronic renal failure (odds ratio [OR], 1.4; 95% CI, 1.27-1.52), chronic pulmonary disease (OR, 1.1; 95% CI, 1.01-1.25), and congestive heart failure (CHF; OR, 1.1; 95% CI, 1.01-1.22). About one-quarter of patients (23.8%) within 30 days after their initial procedure underwent amputation at any level of the lower limb.\n\nCONCLUSION: Tibioperoneal angioplasty is associated with frequent in-hospital complications, an overall 30-day amputation rate of 23.8% for all procedures and indications, and a 30-day rehospitalization rate of almost 30%. Further detailed analysis of tibioperoneal intervention is essential to define best treatment strat\u2026", "author" : [ { "dropping-particle" : "", "family" : "Vogel", "given" : "Todd R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dombrovskiy", "given" : "Viktor Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carson", "given" : "Jeffrey L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Graham", "given" : "Alan M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2011", "7" ] ] }, "page" : "109-15", "publisher" : "Elsevier Inc.", "title" : "In-hospital and 30-day outcomes after tibioperoneal interventions in the US Medicare population with critical limb ischemia.", "type" : "article-journal", "volume" : "54" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁶", "plainTextFormattedCitation" : "6", "previouslyFormattedCitation" : "(6)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }6:37201 Cardiovascular Transcatheter therapy, infusion for thrombolysis other than coronary. 37202 Cardiovascular Transcatheter therapy, infusion other than for thrombolysis, any type (eg, spasmolytic, vasoconstrictive). Intravascular StentICD-9 codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2012.12.031", "ISSN" : "1097-6809", "PMID" : "23541547", "abstract" : "OBJECTIVE: As pressure to contain health care costs increases, there has been greater scrutiny of readmissions in the vascular surgery population. The objective of this study was to evaluate postoperative readmissions after open and endovascular lower extremity (LE) procedures for peripheral artery disease (PAD).\n\nMETHODS: A retrospective cohort study was performed of elective adult inpatients with PAD and LE procedures which were selected from the Health Facts database (Cerner Corporation, Kansas City, Mo) between October 2008 and December 2010 using International Classification of Disease, 9th Clinical Modification diagnosis codes (claudication, rest pain, and ulceration/gangrene) and procedure codes for LE revascularization (endovascular and open). Multivariable logistic regression and \u03c7(2) were used to compare patients who received endovascular and open procedures. The Charlson Comorbidity Index, comorbid diagnoses, and laboratory results were used to adjust for confounding. The main outcome measure evaluated was readmission \u2264 30 days of discharge.\n\nRESULTS: Of 463,362 index admissions, 16,574 patients were identified with a diagnosis of PAD. Combining PAD with elective LE procedures during the index admission, 777 underwent open and 681 underwent endovascular procedures. Unadjusted readmission rates for open and endovascular procedures for claudication, rest pain, and ulceration/gangrene were 10.2% vs 11.3% (P = .69), 14.0% vs 18.2% (P = .43), and 21.1% vs 19.5% (P = .69), respectively. Readmission increased by the severity of the diagnosis for open and endovascular procedures (P = .0006). Men comprised 58% of the cohort; readmission rates were not statistically different by sex (P = .19). Race was not associated with procedure performed (P = .16), but nonwhite race was associated with more severe PAD (P < .0001). After adjusting for race, sex, comorbidities, length of stay, and laboratory values outside of normal reference ranges, the association between an endovascular procedure and readmission was not statistically significant (odds ratio, 1.28; 95% confidence interval, 0.94-1.75).\n\nCONCLUSIONS: Less invasive endovascular procedures were not associated with decreased readmission rates compared with open surgery. The overall readmission rate for claudicant patients was 10.7%, which was unexpectedly high. Predictors of readmission included male sex, longer hospital stays, hospital infection, elevated aspartate aminotransferase, and high numbers of\u2026", "author" : [ { "dropping-particle" : "", "family" : "Vogel", "given" : "Todd R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kruse", "given" : "Robin L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2013", "7" ] ] }, "page" : "90-7.e1-4", "publisher" : "Society for Vascular Surgery", "title" : "Risk factors for readmission after lower extremity procedures for peripheral artery disease.", "type" : "article-journal", "volume" : "58" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jvs.2011.02.035", "ISSN" : "1097-6809", "PMID" : "21571495", "abstract" : "OBJECTIVE: Black patients with peripheral arterial disease undergo amputation at two to four times the rate of white patients. In order to determine whether differences in attempts at limb salvage might contribute to this disparity, we studied the limb care received prior to amputation by black patients compared with whites.\n\nMETHODS: Using inpatient Medicare data for the years 2003 through 2006, we identified a retrospective sample of all beneficiaries who underwent major lower extremity amputation. \"Limb salvage care\" was defined as limb-related admissions and procedures that occurred during the 2 years prior to amputation. We used multiple logistic regression to compare rates of revascularization and other limb care received by black versus white amputees, adjusting for individual patient characteristics. We then controlled for hospital referral region in order to assess whether differences in care might be attributable to the geographic regions in which black and white patients received care. Finally, we examined the timing of revascularization relative to amputation for both races.\n\nRESULTS: Our sample included 24,600 black and 65,881 white amputees. Compared with whites, black amputees were more likely to be female and had lower socioeconomic status. Average age, rates of diabetes, and levels of comorbidity were similar between races. Black amputees were significantly less likely than whites to have undergone revascularization (23.6% vs 31.6%; P < .0001), any limb-related admission (39.6% vs 44.7%; P < .0001), toe amputation (12.9% vs 13.8%; P < .0005), or wound debridement (11.6% vs 14.2%; P < .0001) prior to amputation. After adjusting for differences in individual patient characteristics, black amputees remained significantly less likely than whites to undergo revascularization (odds ratios [OR], 0.72 [95% confidence interval, .68-.76]), limb-related admission (OR, 0.81 [0.78-0.84]), or wound debridement prior to amputation (OR, 0.80 [0.75-0.85]). Timing of revascularization relative to amputation was similar between races. Observed differences in care were shown to exist within hospital referral regions and were not accounted for by regional differences in where black and white patients received care.\n\nCONCLUSION: Black patients are much less likely than whites to undergo attempts at limb salvage prior to amputation. Further studies should explore whether this disparity might be attributable to race-related differences in severity of arterial \u2026", "author" : [ { "dropping-particle" : "", "family" : "Holman", "given" : "Kerianne H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henke", "given" : "Peter K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dimick", "given" : "Justin B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Birkmeyer", "given" : "John D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "2011", "8" ] ] }, "page" : "420-6, 426.e1", "publisher" : "Elsevier Inc.", "title" : "Racial disparities in the use of revascularization before leg amputation in Medicare patients.", "type" : "article-journal", "volume" : "54" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^1,2", "plainTextFormattedCitation" : "1,2", "previouslyFormattedCitation" : "(1,2)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1,239.90 Insertion of nondrug-eluting peripheral vessel stents(s) 00.55 Insertion of drug-eluting non-coronary stentCPT codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2012.11.068.Regional", "author" : [ { "dropping-particle" : "", "family" : "Goodney", "given" : "Philip P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holman", "given" : "Kerianne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henke", "given" : "Peter K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lori", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dimick", "given" : "Justin B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stukel", "given" : "Therese A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fisher", "given" : "Elliott S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Birkmeyer", "given" : "John D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "1471-1480", "title" : "Regional intensity of vascular care and lower extremity amputation rates", "type" : "article-journal", "volume" : "57" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "(4)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4:37205Transcatheter placement of an intravascular stent(s), (except coronary, carotid, and vertebral vessel), percutaneous; initial vessel37206Transcatheter placement of an intravascular stent(s), (except coronary, carotid, and vertebral vessel), percutaneous; each additional vessel 37207Transcatheter placement of an intravascular stent(s), (noncoronary vessel), open; initial vessel 37208Transcatheter placement of an intravascular stent(s), (noncoronary vessel), open; each additional vesselArthrectomyCPT codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2012.11.068.Regional", "author" : [ { "dropping-particle" : "", "family" : "Goodney", "given" : "Philip P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holman", "given" : "Kerianne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henke", "given" : "Peter K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lori", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dimick", "given" : "Justin B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stukel", "given" : "Therese A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fisher", "given" : "Elliott S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Birkmeyer", "given" : "John D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "1471-1480", "title" : "Regional intensity of vascular care and lower extremity amputation rates", "type" : "article-journal", "volume" : "57" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "(4)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4:35482Transluminal peripheral atherectomy, open; iliac35492Transluminal peripheral atherectomy, percutaneous; iliac35483Transluminal peripheral atherectomy, open; femoral-popliteal35485Transluminal peripheral atherectomy, open; tibioperoneal trunk and branches35493Transluminal peripheral atherectomy, percutaneous; femoral-popliteal35495Transluminal peripheral atherectomy, percutaneous; tibioperoneal trunk and branchesAngiogramCPT codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2010.12.055", "ISSN" : "1097-6809", "PMID" : "21397441", "abstract" : "OBJECTIVES: Catheter-based revascularization has emerged as an alternative to surgical bypass for the tibioperoneal vessels. The purpose of this analysis was to describe the outcomes of tibial angioplasty interventions for critical limb ischemia (CLI) in the hospitalized Medicare population, to examine in-hospital complications, to define the 30-day readmission and mortality rates, and to assess secondary procedures performed in this population.\n\nMETHODS: In-patients with CLI undergoing tibioperoneal angioplasty were identified using The Centers for Medicare & Medicaid Services in-patient claims for 2005 to 2007. In-hospital complications, mortality, 30-day secondary procedures, and 30-day rehospitalization after discharge were described.\n\nRESULTS: A total of 13,258 in-patients underwent tibioperoneal angioplasty (54.2% men; 75.7% white, 17.1% African American; 42.8% gangrene, 46.7% rest pain, 10.5% claudication) and 29.3% had a stent, 47.3% had femoral-popliteal angioplasty, and 20.1% had atherectomy during their initial procedure. Initial hospital complications included renal complications (8.1%), respiratory complications and pneumonia (5.1%), and cardiac complications with acute myocardial infarction (3.2%). Mortality in-hospital was 2.8% and at 30 days was 6.7%. Thirty-day rehospitalization rate was 29.6%. Thirty-day reinterventions included repeat angiogram (8.5%), repeat tibioperoneal angioplasty (3.2%), open bypass (2.1%), and lower extremity amputations (23.8%). Gangrene was the most frequent diagnosis at rehospitalization (13.5%). Patients with gangrene as an indication for tibioperoneal angioplasty were 1.8 times (95% confidence interval [CI], 1.56-2.10) as likely as patients with rest pain to be rehospitalized during 30 days after discharge. Among comorbidities, predictors of 30-day rehospitalization included chronic renal failure (odds ratio [OR], 1.4; 95% CI, 1.27-1.52), chronic pulmonary disease (OR, 1.1; 95% CI, 1.01-1.25), and congestive heart failure (CHF; OR, 1.1; 95% CI, 1.01-1.22). About one-quarter of patients (23.8%) within 30 days after their initial procedure underwent amputation at any level of the lower limb.\n\nCONCLUSION: Tibioperoneal angioplasty is associated with frequent in-hospital complications, an overall 30-day amputation rate of 23.8% for all procedures and indications, and a 30-day rehospitalization rate of almost 30%. Further detailed analysis of tibioperoneal intervention is essential to define best treatment strat\u2026", "author" : [ { "dropping-particle" : "", "family" : "Vogel", "given" : "Todd R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dombrovskiy", "given" : "Viktor Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carson", "given" : "Jeffrey L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Graham", "given" : "Alan M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2011", "7" ] ] }, "page" : "109-15", "publisher" : "Elsevier Inc.", "title" : "In-hospital and 30-day outcomes after tibioperoneal interventions in the US Medicare population with critical limb ischemia.", "type" : "article-journal", "volume" : "54" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁶", "plainTextFormattedCitation" : "6", "previouslyFormattedCitation" : "(6)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }6:36140 Cardiovascular Introduction of needle or intracatheter; extremity artery. 36200 Cardiovascular Introduction of catheter, aorta36245 Cardiovascular Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family.36246 Cardiovascular Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family. 36247 Cardiovascular Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family. 36248 Cardiovascular Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family.75626 Angiogram75630 Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation.Open reinterventionsThrombectomy/ EmbolectomyCPT codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2012.11.068.Regional", "author" : [ { "dropping-particle" : "", "family" : "Goodney", "given" : "Philip P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holman", "given" : "Kerianne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henke", "given" : "Peter K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lori", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dimick", "given" : "Justin B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stukel", "given" : "Therese A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fisher", "given" : "Elliott S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Birkmeyer", "given" : "John D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "1471-1480", "title" : "Regional intensity of vascular care and lower extremity amputation rates", "type" : "article-journal", "volume" : "57" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "(4)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4:37184 Thrombectomy - Prim art mech thrombectomy37185 Thrombectomy - Prim art mech thrombectomy add on34203 Embolectomy – removal of leg artery clot35351 Thromboendarterectomy, including patch graft, if performed; iliac 35355 Thromboendarterectomy, including patch graft, if performed; iliofemoral35302 Thromboendarterectomy, including patch graft, if performed; superficial femoral artery35303 Thromboendarterectomy, including patch graft, if performed; popliteal artery 35304 Thromboendarterectomy, including patch graft, if performed; tibioperoneal trunk artery35305 Thromboendarterectomy, including patch graft, if performed; tibial or peroneal artery 35306 Thromboendarterectomy, including patch graft, if performed; each additional tibial 35371 Thromboendarterectomy, including patch graft, if performed; common femoral 35372 Thromboendarterectomy, including patch graft, if performed; deep (profunda) femoralOpen bypass graft or repairICD-9 codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2012.12.031", "ISSN" : "1097-6809", "PMID" : "23541547", "abstract" : "OBJECTIVE: As pressure to contain health care costs increases, there has been greater scrutiny of readmissions in the vascular surgery population. The objective of this study was to evaluate postoperative readmissions after open and endovascular lower extremity (LE) procedures for peripheral artery disease (PAD). METHODS: A retrospective cohort study was performed of elective adult inpatients with PAD and LE procedures which were selected from the Health Facts database (Cerner Corporation, Kansas City, Mo) between October 2008 and December 2010 using International Classification of Disease, 9th Clinical Modification diagnosis codes (claudication, rest pain, and ulceration/gangrene) and procedure codes for LE revascularization (endovascular and open). Multivariable logistic regression and \u03c7(2) were used to compare patients who received endovascular and open procedures. The Charlson Comorbidity Index, comorbid diagnoses, and laboratory results were used to adjust for confounding. The main outcome measure evaluated was readmission \u2264 30 days of discharge. RESULTS: Of 463,362 index admissions, 16,574 patients were identified with a diagnosis of PAD. Combining PAD with elective LE procedures during the index admission, 777 underwent open and 681 underwent endovascular procedures. Unadjusted readmission rates for open and endovascular procedures for claudication, rest pain, and ulceration/gangrene were 10.2% vs 11.3% (P = .69), 14.0% vs 18.2% (P = .43), and 21.1% vs 19.5% (P = .69), respectively. Readmission increased by the severity of the diagnosis for open and endovascular procedures (P = .0006). Men comprised 58% of the cohort; readmission rates were not statistically different by sex (P = .19). Race was not associated with procedure performed (P = .16), but nonwhite race was associated with more severe PAD (P < .0001). After adjusting for race, sex, comorbidities, length of stay, and laboratory values outside of normal reference ranges, the association between an endovascular procedure and readmission was not statistically significant (odds ratio, 1.28; 95% confidence interval, 0.94-1.75). CONCLUSIONS: Less invasive endovascular procedures were not associated with decreased readmission rates compared with open surgery. The overall readmission rate for claudicant patients was 10.7%, which was unexpectedly high. Predictors of readmission included male sex, longer hospital stays, hospital infection, elevated aspartate aminotransferase, and high numbers of me\u2026", "author" : [ { "dropping-particle" : "", "family" : "Vogel", "given" : "Todd R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kruse", "given" : "Robin L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2013", "7" ] ] }, "page" : "90\u201397.e4", "publisher" : "Society for Vascular Surgery", "title" : "Risk Factors for Readmission after Lower Extremity Procedures for Peripheral Artery Disease.", "type" : "article-journal", "volume" : "58" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jvs.2011.02.035", "ISSN" : "1097-6809", "PMID" : "21571495", "abstract" : "OBJECTIVE: Black patients with peripheral arterial disease undergo amputation at two to four times the rate of white patients. In order to determine whether differences in attempts at limb salvage might contribute to this disparity, we studied the limb care received prior to amputation by black patients compared with whites.\n\nMETHODS: Using inpatient Medicare data for the years 2003 through 2006, we identified a retrospective sample of all beneficiaries who underwent major lower extremity amputation. \"Limb salvage care\" was defined as limb-related admissions and procedures that occurred during the 2 years prior to amputation. We used multiple logistic regression to compare rates of revascularization and other limb care received by black versus white amputees, adjusting for individual patient characteristics. We then controlled for hospital referral region in order to assess whether differences in care might be attributable to the geographic regions in which black and white patients received care. Finally, we examined the timing of revascularization relative to amputation for both races.\n\nRESULTS: Our sample included 24,600 black and 65,881 white amputees. Compared with whites, black amputees were more likely to be female and had lower socioeconomic status. Average age, rates of diabetes, and levels of comorbidity were similar between races. Black amputees were significantly less likely than whites to have undergone revascularization (23.6% vs 31.6%; P < .0001), any limb-related admission (39.6% vs 44.7%; P < .0001), toe amputation (12.9% vs 13.8%; P < .0005), or wound debridement (11.6% vs 14.2%; P < .0001) prior to amputation. After adjusting for differences in individual patient characteristics, black amputees remained significantly less likely than whites to undergo revascularization (odds ratios [OR], 0.72 [95% confidence interval, .68-.76]), limb-related admission (OR, 0.81 [0.78-0.84]), or wound debridement prior to amputation (OR, 0.80 [0.75-0.85]). Timing of revascularization relative to amputation was similar between races. Observed differences in care were shown to exist within hospital referral regions and were not accounted for by regional differences in where black and white patients received care.\n\nCONCLUSION: Black patients are much less likely than whites to undergo attempts at limb salvage prior to amputation. Further studies should explore whether this disparity might be attributable to race-related differences in severity of arterial \u2026", "author" : [ { "dropping-particle" : "", "family" : "Holman", "given" : "Kerianne H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henke", "given" : "Peter K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dimick", "given" : "Justin B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Birkmeyer", "given" : "John D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "2011", "8" ] ] }, "page" : "420-6, 426.e1", "publisher" : "Elsevier Inc.", "title" : "Racial disparities in the use of revascularization before leg amputation in Medicare patients.", "type" : "article-journal", "volume" : "54" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^2,5", "plainTextFormattedCitation" : "2,5", "previouslyFormattedCitation" : "(2,5)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }2,5:38.08 Incision of lower limb arteries 38.18 Endarterectomy of lower limb arteries 38.38 Resection of lower limb arteries with anastomosis 38.48 Resection of lower limb arteries with replacement 39.29 Other (peripheral) vascular shunt or bypass 39.56 Repair of blood vessel with tissue patch graft 39.57 Repair of blood vessel with synthetic patch graft 39.58 Repair of blood vessel with unspecified type of patch graft 39.59 Other repair of vessel CPT codesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2012.11.068.Regional", "author" : [ { "dropping-particle" : "", "family" : "Goodney", "given" : "Philip P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holman", "given" : "Kerianne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henke", "given" : "Peter K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lori", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dimick", "given" : "Justin B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stukel", "given" : "Therese A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fisher", "given" : "Elliott S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Birkmeyer", "given" : "John D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "1471-1480", "title" : "Regional intensity of vascular care and lower extremity amputation rates", "type" : "article-journal", "volume" : "57" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "(4)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4:35563Bypass graft, with vein; ilioiliac 35565Bypass graft, with vein; iliofemoral 35661Bypass graft, with other than vein; femoral-femoral 35663Bypass graft, with other than vein; ilioiliac35665Bypass graft, with other than vein; iliofemoral 35556Bypass graft, with vein; femoral-popliteal 35558Bypass graft, with vein; femoral-femoral35566Bypass graft, with vein; femoral-anterior tibial, posterior tibial, peroneal artery 35571Bypass graft, with vein; popliteal-tibial, -peroneal artery or other distal vessels 35583In-situ vein bypass; femoral-popliteal 35585In-situ vein bypass; femoral-anterior tibial, posterior tibial, or peroneal artery 35587In-situ vein bypass; popliteal-tibial, peroneal 35656Bypass graft, with other than vein; femoral-popliteal 35666Bypass graft, with other than vein; femoral-anterior tibial, posterior tibial, or peroneal artery 35671Bypass graft, with other than vein; popliteal-tibial or -peroneal artery 35879Revision, lower extremity arterial bypass, without thrombectomy, open; with vein patch angioplasty35881Revision, lower extremity arterial bypass, without thrombectomy, open; with segmental vein interposition 35883Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with nonautogenous patch graft35884Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with autogenous vein patch graft 35541Bypass graft, with vein35681Bypass graft; composite, prosthetic and vein 35682Bypass graft; autogenous composite, two segments of veins from two locations Table 3S: Subsequent interventions after endovascular and open lower extremity revascularization for matched groups* Subsequent Interventions, % (95% Confidence Interval)TimeIndex ProcedureAnyEndovascularOpen30-daysEndovascular14.613.52.1Open7.24.14.4Difference+7.4 (6.3,8.5)+9.4 (8.4,10.4)-2.3 (-2.9,1.7)Year 1Endovascular38.335.87.3Open30.724.114.8Difference+7.6 (5.7,9.5)+11.7 (9.9,13.5)-7.5 (-8.8,-6.2)Year 2Endovascular45.342.99.2Open38.331.818.1Difference+7.0 (4.9,9.1)+11.1 (9.0,13.2)-8.9 (-10.3,-7.4)Year 3Endovascular50.047.910.4Open43.737.420.9Difference+6.3 (3.9,8.7)+10.5 (8.0,13.0)-10.5 (-12.2,-8.8)Year 4Endovascular54.051.810.8Open45.439.121.7Difference+8.6 (5.5,11.7)+12.7 (9.6,15.8)-10.9 (-12.8,-9.0)P-value<0.001<0.001<0.001*Data are hierarchical (e.g., a given patient may have undergone and been counted for both a subsequent endovascular intervention and a subsequent open intervention but would have been counted only once for any subsequent intervention); P-values were obtained with the use of log-rank analysis of Kaplan-Meier curves testing the overall difference in event rates between index procedure groups. Rates are cumulative over time.Difference, relative rate difference of endovascular vs. openTable 4S: Adjusted hazard ratios and 95% confidence intervals for overall 4-year amputation or death, endovascular vs. open revascularization, controlling for patient demographics, preoperative characteristics, and perioperative factorsHazard Ratio95% CIP-valueUnadjusted0.870.82-0.91<0.001Adjusted for covariates*0.840.79-0.88<0.001 Adjusted for covariates* with SMR weighting estimation0.840.80-0.88<0.001Adjusted for covariates* with propensity score matching (1 to 1, nearest neighbor, caliper = 0.02)0.840.79-0.89<0.001Adjusted for covariates* with propensity score stratification by quintiles0.830.73-0.940.044*Cox regression model controlling for age, gender, extent of disease, diabetes, renal failure, congestive heart failure/ ischemic heart disease, myocardial infarction, stroke, electrolyte disorder, deficiency anemia, coagulopathy, chronic pulmonary disorder, neurological disorder, dementia, pulmonary circulation disorder, weight loss, cancer, race, eye disease, chronic blood loss anemia, rheumatoid arthritis or collagen vascular disease, complicated hypertension, obesity, benign tumor, Medicaid eligibility ever, hospital and patient rural urban commuting area, hospital type, origin of admission and year of procedure.CI, confidence interval; SMR, standardized mortality ratioTable 5S: Adjusted hazard ratios and 95% confidence intervals for overall 4-year amputation or death, endovascular vs. open revascularization, by controlling for patient demographics, preoperative characteristics, and perioperative factors, stratified by propensity score quintilesQuintileHazard Ratio95% CIP-value10.850.73-0.990.04420.870.76-0.990.03330.860.77-0.980.01840.810.72-0.91<0.00150.790.70-0.88<0.001Each respective Cox regression model controlling for age, gender, extent of disease, diabetes, renal failure, congestive heart failure/ ischemic heart disease, myocardial infarction, stroke, electrolyte disorder, deficiency anemia, coagulopathy, chronic pulmonary disorder, neurological disorder, dementia, pulmonary circulation disorder, weight loss, cancer, race, eye disease, chronic blood loss anemia, rheumatoid arthritis or collagen vascular disease, complicated hypertension, obesity, benign tumor, Medicaid eligibility ever, hospital and patient rural urban commuting area, hospital type, origin of admission and year of procedure.CI, confidence interval A. AFS by procedure type and presence of DMB. AFS by procedure type and presence of RF C. AFS by procedure type and presence of CHF/IHDD. AFS by procedure type and presence of CLI Figure 1S. Overall 4-year amputation free survival by endovascular vs. open revascularization and comorbidity in propensity score matched cohorts. A, 4-year amputation free survival by procedure type and presence of diabetes mellitus; B, 4-year amputation free survival by procedure type and presence of renal failure; C, 4-year amputation free survival by procedure type and presence of congestive heart failure/ischemic heart disease; D, 4-year amputation free survival by procedure type and extent of disease. AFS, amputation free survival; RF, renal failure; DM, diabetes mellitus; CLI, critical limb ischemia, CHF/IHD, congestive heart failure / ischemic heart disease, Endo, endovascular. REFERENCES1. Vogel TR, Kruse RL. Risk factors for readmission after lower extremity procedures for peripheral artery disease. J Vasc Surg 2013; 58: 90–97. 2. Holman KH, Henke PK, Dimick JB, et al. Racial disparities in the use of revascularization before leg amputation in Medicare patients. J Vasc Surg 2011; 54: 420–426. 3. Goodney PP, Beck AW, Nagle J, et al. National trends in lower extremity bypass surgery, endovascular interventions, and major amputations. J Vasc Surg 2009; 50: 54–60. 4. Goodney PP, Holman K, Henke PK, et al. Regional intensity of vascular care and lower extremity amputation rates. J Vasc Surg 2013; 57: 1471–1480. 5. Vogel TR, Kruse RL. Risk Factors for Readmission after Lower Extremity Procedures for Peripheral Artery Disease. J Vasc Surg 2013; 58: 90–97. 6. Vogel TR, Dombrovskiy VY, Carson JL, et al. In-hospital and 30-day outcomes after tibioperoneal interventions in the US Medicare population with critical limb ischemia. J Vasc Surg 2011; 54: 109–115. ................
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