Lower extremity percutaneous transluminal angioplasty (LE PTA) is currently performed by a variety of endovascular specialists. We hypothesized that cardiologists (CRD) and vascular surgeons (VAS) may have different practice patterns, thresholds for intervention, and hospital utilization.
Methods
Analysis of the State Inpatient Databases for New Jersey (2003-2007). Patients with elective admission undergoing PTA procedures with indications of claudication, rest pain, and ulceration/gangrene were examined. Physician specialty was determined based on all procedures performed. LE PTA was analyzed with respect to specialty, indication for the procedure, volume, and resource utilization.
Results
1887 cases of LE PTA were identified [VAS 866 (45.9%) and CRD 1021 (54.1%)]. Mean age was 69.7 (CRD) vs. 71.7(VAS), p=0.0049. Indications for intervention were compared for CRD vs. VAS: claudication 80.7% vs. 60.7%, (p<0.002); rest pain 6.2% vs. 16.0%, (p<0.002); gangrene/ulceration 13.1% vs. 23.3%, (p<0.002). Stents (64.8% of cases) were utilized similarly among physicians (p=.18) and practitioners had similar lengths of stay (2.38 days vs. 2.41 days, p=0.85). Hospital charges by indication varied between CRD vs. VAS: All procedures: $56,687 vs. $44,077 (p<0.001); claudication: $46,669 vs. $ 38,100 (p<.0001); rest pain $59,034 vs. $39,755 (p<0.0009); gangrene/ulceration $64,357 vs. $54,375 (p=0.018). Revenue center charges were different between CRD vs. VAS: Medical surgical supply $18,906 vs. $12,920, (p<0.001); Pharmacy $3,197 vs. $1,281, (p<0.001). Only 10.7% of CRD were high volume practitioners compared to 36.8% of VAS (p<0.05). High volume practitioners had significantly lower hospital charges ($42,168 vs. $ 50,967, p<0.001).
Conclusions
Cardiologists performing lower extremity angioplasty were more likely to treat patients with claudication than rest pain or gangrene. Despite treating younger patients with less severe peripheral vascular disease, cardiologists used significantly greater hospital resources. High practitioner volume, regardless of specialty, was associated with lower hospital resource utilization. Tempering lower extremity intervention based on indication and practitioner volume may permit future cost savings.
UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
Author Disclosures: T.R. Vogel, American Heart Association; V.Y. Dombrovskiy, None; P.B. Haser, None; J.L. Carson, National Heart, Lung, and Blood Institute; A.M. Graham, None.
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