Procedural Volume and Outcomes in Lower-Extremity Peripheral Vascular Interventions: Insights From the NCDR...

Lower-extremity peripheral vascular interventions (PVIs) are increasingly used for treatment of peripheral artery disease. However, the relationship between hospital and operator PVI volume with in-hospital major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) is not well established.

We used the NCDR PVI (National Cardiovascular Data Registry) registry, including procedural data from April 1, 2014, to December 31, 2019, assessing in-hospital MALEs and MACEs during hospitalization for PVI. Annualized PVI volumes were categorized on the basis of operator or site volume. Generalized linear mixed models assessed volume-outcome relationships after adjustment of covariates.

Between 2014 and 2019, 55 785 PVI procedures were performed at 97 hospitals by 555 operators. Adjusted analysis showed no statistically significant association between hospital volume and MALEs (highest versus lowest volume: odds ratio, 0.91 [95% CI, 0.74-1.11]; P=0.35) or hospital volume and MACEs (highest versus lowest volume: odds ratio, 1.23 [95% CI, 0.95-1.16]; P=0.12). Notably, undergoing PVI with high-volume operators was associated with lower odds of in-hospital MALEs (odds ratio, 0.73 [95% CI, 0.55-0.97]; P=0.03) and MACEs (odds ratio, 0.64 [95% CI, 0.44-0.95]; P=0.03). Female sex and comorbidities including dyslipidemia, prior percutaneous coronary intervention, heart failure, and acute or chronic limb ischemia were associated with higher MALE risk. Older age and comorbidities including hypertension, dyslipidemia, end-stage renal disease requiring dialysis, severe lung disease, prior myocardial infarction, heart failure, and acute limb ischemia were associated with greater MACE risk.

In contemporary practice, a significant relationship was observed between operator volume and adjusted PVI outcomes. Highest-volume operators had lower rates of in-hospital MALEs and MACEs compared with lowest-volume operators.