Benchmarking Surgeon Performance in Lower Extremity Revascularization Using a Composite Outcome Metric

Area of Science:

• Vascular Surgery
• Health Services Research
• Quality Improvement

Background:

• Peripheral artery disease (PAD) programs require consistent surgical outcomes for limb salvage.
• Surgeon-level benchmarking is limited despite the known influence of procedural volume.
• The Limb Evaluation and Amputation Prevention Program (LEAPP) is a multidisciplinary limb salvage initiative.

Purpose of the Study:

• Analyze surgeon performance in limb salvage for PAD.
• Investigate volume-outcome patterns using a composite quality assessment framework.

Main Methods:

• Single-center study of 147 PAD patients undergoing lower extremity revascularization.
• Primary outcome: adverse event-free survival (AEFS) at 1 year.
• Surgeon performance assessed via composite z-score (adverse event rates, O/E ratios, hazard ratios).

Main Results:

• 70.5% had chronic limb-threatening ischemia; 21.1% experienced an adverse event (bleeding, thrombosis, amputation).
• No significant differences in AEFS or complication rates across surgeons.
• Higher-volume surgeons had numerically lower intraoperative blood loss and positive composite z-scores.

Conclusions:

• Surgeon-level outcomes in PAD limb salvage were consistent.
• A directional volume-outcome relationship was observed, with higher-volume surgeons performing better.
• The composite scoring framework is a feasible tool for surgeon benchmarking and quality improvement.