High Reintervention and Amputation Rates After Outpatient Atherectomy for Claudication

Dipankar Mukherjee, Brian Contos, Erica Emery, Devon T. Collins, James Hamilton Black

Research output: Contribution to journalArticle

Abstract

Outpatient use of atherectomy for peripheral arterial disease has grown rapidly and outcomes are poorly understood. We analyzed outcomes of atherectomy done for claudication, comparing office and hospital outpatient settings. Analysis of Medicare Part B claims data was performed for incident femoral–popliteal or tibial–peroneal atherectomy from 2012 to 2014. Longitudinal analysis assessed services 18 months before, during, and up to 18 months after the incident peripheral vascular intervention (PVI). Differences between office-based and hospital outpatient-based settings were assessed using χ2 and Fisher exact tests. Comparing procedure settings, significant differences in race (femoral–popliteal: P =.04, tibial–peroneal: P =.001), chronic renal failure (femoral–popliteal: P =.002), and hypertension (femoral–popliteal: P =.01, tibial–peroneal: P =.006) were found. Nine hundred twenty-four patients undergoing femoral–popliteal atherectomy were analyzed (262 office based, 662 hospital outpatient based); 42.7% of office-based and 36.9% of hospital outpatient-based femoral–popliteal atherectomy patients had repeat PVI within 18 months (P =.10). Major amputation was performed in 2.3% and 3.2% of patients in office and hospital outpatient settings, respectively (P =.47). Four hundred twenty-three patients undergoing tibial–peroneal atherectomy were analyzed (202 office based, 221 hospital outpatient based); 46.5% of office-based and 38.9% of hospital outpatient-based tibial–peroneal atherectomy patients had repeat PVI within 1 year (P =.11). Major amputation was performed in 5.0% and 8.1% of patients in office and hospital outpatient settings, respectively (P =.19). Our study demonstrates higher than expected rates of major amputation for patients undergoing peripheral arterial atherectomy with regard to previously reported rates. Further studies may be required to prove the efficacy and safety of atherectomy for occlusive disease in the femoral–popliteal and tibial–peroneal segments to ensure outcomes are not worse than the natural history of medically managed claudicants.

Original languageEnglish (US)
JournalVascular and Endovascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Atherectomy
Amputation
Outpatients
Blood Vessels
Medicare Part B
Peripheral Arterial Disease
Natural History
Chronic Kidney Failure
Hypertension
Safety

Keywords

  • amputation
  • atherectomy
  • claudication
  • endovascular therapy
  • Medicare
  • peripheral artery disease (PAD)
  • reimbursement

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

High Reintervention and Amputation Rates After Outpatient Atherectomy for Claudication. / Mukherjee, Dipankar; Contos, Brian; Emery, Erica; Collins, Devon T.; Black, James Hamilton.

In: Vascular and Endovascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

@article{15493669327349a895881f3d2583f336,
title = "High Reintervention and Amputation Rates After Outpatient Atherectomy for Claudication",
abstract = "Outpatient use of atherectomy for peripheral arterial disease has grown rapidly and outcomes are poorly understood. We analyzed outcomes of atherectomy done for claudication, comparing office and hospital outpatient settings. Analysis of Medicare Part B claims data was performed for incident femoral–popliteal or tibial–peroneal atherectomy from 2012 to 2014. Longitudinal analysis assessed services 18 months before, during, and up to 18 months after the incident peripheral vascular intervention (PVI). Differences between office-based and hospital outpatient-based settings were assessed using χ2 and Fisher exact tests. Comparing procedure settings, significant differences in race (femoral–popliteal: P =.04, tibial–peroneal: P =.001), chronic renal failure (femoral–popliteal: P =.002), and hypertension (femoral–popliteal: P =.01, tibial–peroneal: P =.006) were found. Nine hundred twenty-four patients undergoing femoral–popliteal atherectomy were analyzed (262 office based, 662 hospital outpatient based); 42.7{\%} of office-based and 36.9{\%} of hospital outpatient-based femoral–popliteal atherectomy patients had repeat PVI within 18 months (P =.10). Major amputation was performed in 2.3{\%} and 3.2{\%} of patients in office and hospital outpatient settings, respectively (P =.47). Four hundred twenty-three patients undergoing tibial–peroneal atherectomy were analyzed (202 office based, 221 hospital outpatient based); 46.5{\%} of office-based and 38.9{\%} of hospital outpatient-based tibial–peroneal atherectomy patients had repeat PVI within 1 year (P =.11). Major amputation was performed in 5.0{\%} and 8.1{\%} of patients in office and hospital outpatient settings, respectively (P =.19). Our study demonstrates higher than expected rates of major amputation for patients undergoing peripheral arterial atherectomy with regard to previously reported rates. Further studies may be required to prove the efficacy and safety of atherectomy for occlusive disease in the femoral–popliteal and tibial–peroneal segments to ensure outcomes are not worse than the natural history of medically managed claudicants.",
keywords = "amputation, atherectomy, claudication, endovascular therapy, Medicare, peripheral artery disease (PAD), reimbursement",
author = "Dipankar Mukherjee and Brian Contos and Erica Emery and Collins, {Devon T.} and Black, {James Hamilton}",
year = "2018",
month = "1",
day = "1",
doi = "10.1177/1538574418772459",
language = "English (US)",
journal = "Vascular and Endovascular Surgery",
issn = "1538-5744",
publisher = "SAGE Publications Inc.",

}

TY - JOUR

T1 - High Reintervention and Amputation Rates After Outpatient Atherectomy for Claudication

AU - Mukherjee, Dipankar

AU - Contos, Brian

AU - Emery, Erica

AU - Collins, Devon T.

AU - Black, James Hamilton

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Outpatient use of atherectomy for peripheral arterial disease has grown rapidly and outcomes are poorly understood. We analyzed outcomes of atherectomy done for claudication, comparing office and hospital outpatient settings. Analysis of Medicare Part B claims data was performed for incident femoral–popliteal or tibial–peroneal atherectomy from 2012 to 2014. Longitudinal analysis assessed services 18 months before, during, and up to 18 months after the incident peripheral vascular intervention (PVI). Differences between office-based and hospital outpatient-based settings were assessed using χ2 and Fisher exact tests. Comparing procedure settings, significant differences in race (femoral–popliteal: P =.04, tibial–peroneal: P =.001), chronic renal failure (femoral–popliteal: P =.002), and hypertension (femoral–popliteal: P =.01, tibial–peroneal: P =.006) were found. Nine hundred twenty-four patients undergoing femoral–popliteal atherectomy were analyzed (262 office based, 662 hospital outpatient based); 42.7% of office-based and 36.9% of hospital outpatient-based femoral–popliteal atherectomy patients had repeat PVI within 18 months (P =.10). Major amputation was performed in 2.3% and 3.2% of patients in office and hospital outpatient settings, respectively (P =.47). Four hundred twenty-three patients undergoing tibial–peroneal atherectomy were analyzed (202 office based, 221 hospital outpatient based); 46.5% of office-based and 38.9% of hospital outpatient-based tibial–peroneal atherectomy patients had repeat PVI within 1 year (P =.11). Major amputation was performed in 5.0% and 8.1% of patients in office and hospital outpatient settings, respectively (P =.19). Our study demonstrates higher than expected rates of major amputation for patients undergoing peripheral arterial atherectomy with regard to previously reported rates. Further studies may be required to prove the efficacy and safety of atherectomy for occlusive disease in the femoral–popliteal and tibial–peroneal segments to ensure outcomes are not worse than the natural history of medically managed claudicants.

AB - Outpatient use of atherectomy for peripheral arterial disease has grown rapidly and outcomes are poorly understood. We analyzed outcomes of atherectomy done for claudication, comparing office and hospital outpatient settings. Analysis of Medicare Part B claims data was performed for incident femoral–popliteal or tibial–peroneal atherectomy from 2012 to 2014. Longitudinal analysis assessed services 18 months before, during, and up to 18 months after the incident peripheral vascular intervention (PVI). Differences between office-based and hospital outpatient-based settings were assessed using χ2 and Fisher exact tests. Comparing procedure settings, significant differences in race (femoral–popliteal: P =.04, tibial–peroneal: P =.001), chronic renal failure (femoral–popliteal: P =.002), and hypertension (femoral–popliteal: P =.01, tibial–peroneal: P =.006) were found. Nine hundred twenty-four patients undergoing femoral–popliteal atherectomy were analyzed (262 office based, 662 hospital outpatient based); 42.7% of office-based and 36.9% of hospital outpatient-based femoral–popliteal atherectomy patients had repeat PVI within 18 months (P =.10). Major amputation was performed in 2.3% and 3.2% of patients in office and hospital outpatient settings, respectively (P =.47). Four hundred twenty-three patients undergoing tibial–peroneal atherectomy were analyzed (202 office based, 221 hospital outpatient based); 46.5% of office-based and 38.9% of hospital outpatient-based tibial–peroneal atherectomy patients had repeat PVI within 1 year (P =.11). Major amputation was performed in 5.0% and 8.1% of patients in office and hospital outpatient settings, respectively (P =.19). Our study demonstrates higher than expected rates of major amputation for patients undergoing peripheral arterial atherectomy with regard to previously reported rates. Further studies may be required to prove the efficacy and safety of atherectomy for occlusive disease in the femoral–popliteal and tibial–peroneal segments to ensure outcomes are not worse than the natural history of medically managed claudicants.

KW - amputation

KW - atherectomy

KW - claudication

KW - endovascular therapy

KW - Medicare

KW - peripheral artery disease (PAD)

KW - reimbursement

UR - http://www.scopus.com/inward/record.url?scp=85046774129&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046774129&partnerID=8YFLogxK

U2 - 10.1177/1538574418772459

DO - 10.1177/1538574418772459

M3 - Article

C2 - 29716476

AN - SCOPUS:85046774129

JO - Vascular and Endovascular Surgery

JF - Vascular and Endovascular Surgery

SN - 1538-5744

ER -