Characterizing Endovascular Aortic Interventions By Physician Specialty And Hospital Type
*Andres Guerra, *Matthew C Chia, *Joseph M Feinglass, *Ashley K Vavra
Northwestern University Feinberg School of Medicine, Chicago, IL
Minimally invasive repair of aortic pathologies has decreased perioperative morbidity and has been adopted by multiple physician specialties. We aim to evaluate patient characteristics and outcomes of endovascular aortic interventions by different physician specialties and hospital types.
METHODS: Endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) procedures were obtained from the Illinois Hospital Association Comparative Health Care and Hospital Data Reporting Services database from 2016 to 2019. Physician specialties were identified using National Provider Identifier numbers and teaching hospitals identified by the Council of Teaching Hospitals directory. Chi square tests, Kruskal Wallis tests, and multivariable regression were used to test the significance of differences in outcomes by patient, physician and hospital characteristics.
RESULTS: 5,776 admissions were managed by 349 physicians (136 vascular surgeons, 60 interventional radiologists, 75 interventional cardiologists and 78 cardiac surgeons) at 84 hospitals. Interventional cardiologists and cardiac surgeons performed endovascular interventions mostly at community hospitals (91.2% and 79.9% respectively p<0.01) where less interventions were performed for rupture pathology compared to teaching hospitals (3.45% versus 7.36% respectively; p<0.001). These specialties had lower Charlson Comorbidity Index patients compared to vascular surgeons (median 2, IQR [1 - 3] versus median 2, IQR [1 - 4]; p=0.03). On multivariable analysis the likelihood of inpatient mortality was associated with hospital type (teaching IRR 1.79 (95% CI 1.05 - 3.04) versus community), indication (rupture IRR 12.76 (95% CI 7.34 - 22.18) versus non-ruptured pathology) and age (>/= 80 years IRR 1.92 (95% CI 1.14 - 3.25) versus age < 65), with no difference noted between specialties. Hospital stay > 2 days was associated with hospital type (teaching OR 1.53 (95% CI 1.16 - 2.01)), procedure (TEVAR OR 2.61 (95% CI 2.09 - 3.26)), physician specialty (interventional cardiology OR 0.67 (95% CI 0.47 - 0.95) versus vascular surgeons), and race (non-Hispanic Black OR 1.68 (95% CI 1.31 - 2.16) versus non-Hispanic White).
CONCLUSIONS: Vascular surgery patients have a higher burden of comorbidities though no differences in inpatient mortality were noted between specialties. Teaching hospitals tend to have increased inpatient mortality and hospital stay compared to community hospitals and racial disparities persist.
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