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The influence of vascular certification on lower extremity revascularization at one institution
1Department of Surgery, Maricopa Medical Center, Phoenix, Arizona 85008.
Insights
Vascular certification improved lower extremity revascularization outcomes. Certified vascular surgeons provided care to more patients, reducing mortality and complications.
Area of Science:
- Vascular Surgery
- Surgical Outcomes
- Healthcare Quality Improvement
Background:
- Vascular surgery practice at a county hospital was evaluated before and after establishing a dedicated vascular surgery service.
- The study aimed to assess the impact of vascular certification on clinical practice and patient outcomes.
Purpose of the Study:
- To analyze the effect of vascular certification on lower extremity revascularization results.
- To compare outcomes between a period before and after the institution of a vascular surgery service.
Main Methods:
- Retrospective analysis of lower extremity revascularization cases over two 2-year periods.
- Comparison of patient demographics, indications, procedures, mortality, morbidity, and graft infections.
Main Results:
- Mortality decreased from 14% to 3% (P < 0.025).
- Limb thrombosis/embolus rates dropped from 32% to 11% (P < 0.005).
- Graft infections were eliminated (10% to 0%, P < 0.001), with increased case volume and limb salvage focus.
Conclusions:
- Vascular certification led to improved patient selection and more appropriate indications for surgery.
- Certified vascular surgeons enhanced diagnostic work-up and utilized refined techniques, resulting in better outcomes.
- The establishment of a vascular surgery service positively impacted patient care and reduced adverse events.
Abstract:
The potential impact of vascular certification on the practice of vascular surgery at Maricopa Medical Center (Phoenix, AZ) was analyzed by comparison of lower extremity revascularization results over consecutive 2-year periods before (Period I) and after (Period II) institution of vascular surgery service. The overall setting (county hospital, surgical residency) and ancillary services (Anesthesia, Intensive Care Unit, Radiology) were unchanged, except for the authors' use of invasive hemodynamic support. In Period I, there were 49 cases (30 inflow, 19 outflow) with 14 per cent (7/49) mortality, 32 per cent (21/67) limb thrombosis or embolus, and 10 per cent (5/49) graft infection; 80 per cent (39/49) of operations were done for claudication; 20 per cent (10/49) were done for inappropriate indications (P less than 0.005). In Period II, there were 110 cases (47 inflow, 63 outflow). The increase in cases was predominantly due to increased use of extra-anatomic inflow and complex infrapopliteal outflow reconstructions. Seventy per cent (77/110) of operations were done for limb salvage; of 17 aortic cases, 3 were "re-do's" and 5 underwent simultaneous renal revascularization. There was a 3 per cent (4/110) mortality (P less than 0.025), 11 per cent (13/137) limb thrombosis or embolus (P less than 0.005), and no graft infections (P less than 0.001). Lower extremity revascularization delivered by certified vascular surgeons was offered to more patients with lower overall mortality and morbidity rates after more thorough diagnostic work-up and for more appropriate indications, with concomitant use of more refined vascular techniques/procedures.(ABSTRACT TRUNCATED AT 250 WORDS)