Carotid artery stenting: Impact of practitioner specialty and volume on outcomes and resource utilization
Todd R Vogel1, Viktor Y Dombrovskiy, Paul B Haser
1Division of Vascular Surgery, The Surgical Outcomes Research Group, University of Medicine and Dentistry, New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ 08903-0019, USA. vogelto@umdnj.edu
Insights
Carotid artery stenting (CAS) outcomes show no significant difference in stroke rates among specialists. Vascular surgeons utilized fewer hospital resources for CAS, and higher practitioner volume correlated with lower resource use.
Area of Science:
- Endovascular surgery
- Health services research
- Interventional cardiology
Background:
- Carotid artery stenting (CAS) is performed by various endovascular specialists.
- Limited data exist on practice variations and resource utilization among these specialists.
Purpose of the Study:
- To analyze differences in CAS outcomes and hospital resource utilization based on practitioner specialty.
- To compare outcomes between radiologists (RAD), cardiologists (CRD), and vascular surgeons (VAS).
Main Methods:
- Secondary data analysis of the 2005-2006 New Jersey State Inpatient Databases.
- Inclusion of patients undergoing elective CAS within two days of hospital admission.
- Analysis of CAS outcomes, complications, and hospital resource utilization by practitioner specialty and volume.
Main Results:
- Vascular surgeons (VAS) had significantly shorter mean hospital length of stay (LOS) and lower total hospital costs compared to radiologists (RAD) and cardiologists (CRD).
- Intensive care unit (ICU) LOS was significantly shorter for VAS and CRD compared to RAD.
- Medical supply costs were significantly higher for CRD compared to VAS and RAD.
- Stroke and cardiac complication rates did not significantly differ by specialty.
- High-volume practitioners demonstrated significantly lower total hospital cost, LOS, and medical supply costs.
Conclusions:
- CAS outcomes, specifically stroke rates, are comparable across different endovascular specialist groups.
- Significant variations in hospital resource utilization exist, with vascular surgeons showing the lowest utilization.
- Higher practitioner volume is associated with reduced hospital resource utilization, suggesting potential for cost savings and improved efficiency in carotid interventions.
Objectives:
A variety of endovascular specialists perform carotid artery stenting (CAS), but little data exist on outcomes and resource utilization among these specialists. We analyzed differences in outcomes after CAS was performed by radiologists (RAD), cardiologists (CRD), and vascular surgeons (VAS).
Methods:
Secondary data analysis of the 2005-2006 State Inpatient Databases for New Jersey were analyzed. Patients with elective admission to the hospital who had CAS procedure
Results:
We identified 625 CAS cases. CRD performed 378 (60.5%), VAS, 199 (31.8%); and RAD, 48 (7.7%). The overall stroke rate was 2.72% and by specialty was CRD, 3.17%; VAS, 2.01%, and RAD, 2.08% (P = .6880). The overall cardiac complication rate was 2.40% (CRD, 2.12%; VAS, 3.02%; RAD, 2.08%; P = .7899). Renal and pulmonary complications were low (0.64% and 0.32%, respectively). Mean hospital length of stay (LOS) in days was significantly shorter for VAS (1.64 +/- 1.40) compared with RAD (2.83 +/- 5.15; P = .0167) and had the same trend compared with CRD (2.14 +/- 3.37; P = .0649). Intensive care unit (ICU) LOS was shorter for VAS (0.52 +/- 0.97) and CRD (0.30 +/- 0.71) than for RAD (2.12 +/- 4.48; P < .0001). The mean total hospital cost was significantly greater for RAD ($20,987 +/- $26,603) and CRD ($18,182 +/- $16,364) than for VAS ($10,000 +/- $4947; P = .0011 and P < .0001, respectively). ICU cost for RAD ($5963 +/- $14,551) was also more than for VAS ($864 +/- $1514; P < .0001) and CRD ($473 +/- $1561; P < .0001). Medical supply costs were significantly greater for CRD ($8772 +/- $9546) than for VAS ($3354 +/- $2261; P < .0001) and RAD ($4964 +/- $2595; P = .0142). Total hospital cost, LOS, and medical supplies were significantly lower for high-volume practitioners vs low-volume practitioners (P < .0001).
Conclusion:
Stroke rates after CAS did not vary significantly among practitioner specialties. Hospital resource utilization did vary significantly: Vascular surgeons had the lowest utilization of hospital resources for performing CAS. High practitioner volume was associated with lower hospital resource utilization. Elucidation of factors creating resource utilization disparities among endovascular practitioners may lead to improved patient outcomes and permit significant future cost savings for carotid interventions.