• Jeffrey E Indes, Charles T Tuggle, Anant Mandawat, Bart E Muhs, and Julie A Sosa.
• Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA. jeffrey.indes@yale.edu
• Arch Surg. 2011 Aug 1; 146 (8): 966-71.

ObjectiveTo evaluate the effect of physician volume and specialty and hospital volume on population-level outcomes after endovascular repair of aortoiliac occlusive disease (AIOD).DesignA retrospective cross-sectional analysis of all inpatients undergoing endovascular repair of AIOD. Physician volume was classified as low (<17 procedures per year [<50th percentile]) or high (≥17 procedures per year). Physicians were defined as surgeons if they performed at least 1 carotid, aortic, or iliac endarterectomy; open aortic repair; above- or below-knee amputation; or aortoiliac-femoral bypass. Hospital volume was low (<116 procedures per year [<50th percentile]) or high (≥116 procedures per year).PatientsEight hundred eighteen inpatients who underwent endovascular repair of AIOD in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from January 2003 through December 2007.SettingNational hospital database.Main Outcome MeasuresIn-hospital complications and mortality, length of stay, and cost.ResultsOf the 818 procedures, 59.0% of high-volume physicians were surgeons and 65.0% practiced at high-volume hospitals. Unadjusted complication rates were significantly higher for low-volume compared with high-volume physicians (18.7% vs 12.6%; P = .02); rates were not significantly different by physician specialty (P = .88) or hospital volume (P = .16). Shorter length of stay was associated with high-volume physicians (P = .001), high-volume hospitals (P = .001), and surgeon providers (P = .03), whereas decreased cost was associated with physician specialty (P = .004). On multivariate analysis, high physician volume was associated with significantly lower complications (P = .04); high hospital volume, with shorter length of stay (P = .002); and nonsurgeons, with higher costs (P = .05).ConclusionsOverall, volume at the physician and hospital levels appears to be a robust predictor of patient outcomes after endovascular interventions for AIOD. Surgeons performing endovascular procedures for AIOD have a decreased associated hospital cost compared with nonsurgeons.

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