Journal of vascular surgery
-
The Endovascular aneurysm repair Risk Assessment (ERA) model predicts survival (early death, 3-year survival, and 5-year survival), reinterventions, and endoleaks after elective endovascular aneurysm repair. We externally validated the ERA model in our cohort of patients. ⋯ The predictions of survival, reinterventions, and endoleaks made by the ERA model were not sufficiently accurate to be used in our clinical practice.
-
Multicenter Study
Rehospitalization to primary versus different facilities following abdominal aortic aneurysm repair.
Reducing readmissions represents a unique opportunity to improve care and reduce health care costs and is the focus of major payers. A large number of surgical patients are readmitted to hospitals other than where the primary surgery was performed, resulting in clinical decisions that do not incorporate the primary surgeon and potentially alter outcomes. This study characterizes readmission to primary vs different hospitals after abdominal aortic aneurysm (AAA) repair and examines the implications with regard to mortality and cost. ⋯ Readmission to a different facility after AAA repair is common and occurs more frequently than for the overall Medicare population. Patients travelling a greater distance for AAA repair are more likely to return to different vs the primary hospital when further care is required. For AAA repair, quality healthcare may be achieved at marginally lower cost and with greater patient convenience for selected readmissions at hospitals other than where the initial procedure was performed.
-
Multicenter Study
Reliability of hospital readmission rates in vascular surgery.
The Center for Medicare and Medicaid Services recently began assessing financial penalties to hospitals with high readmission rates for a narrow set of medical conditions. Because these penalties will be extended to surgical conditions in the near future, we sought to determine whether readmissions are a reliable predictor of hospital performance with vascular surgery. ⋯ Risk-adjusted readmission rates for vascular surgery vary substantially year to year; this implies that much of the observed variation in readmission rates is either random or caused by unmeasured factors and not caused by changes in hospital quality that may be captured by administrative data.
-
Multicenter Study Comparative Study
Contemporary comparison of supra-aortic trunk surgical reconstructions for occlusive disease.
Open surgical reconstruction for supra-aortic trunk occlusive disease persists despite advances in endovascular therapy. Although extrathoracic reconstructions developed as a safer alternative to transthoracic reconstructions, contemporary national data evaluating relative rates of operative outcomes are lacking. ⋯ At U.S. hospitals, extrathoracic reconstruction is the more common reconstruction for supra-aortic trunk occlusive disease. Both approaches carry acceptably low rates of death, MI, and stroke. Transthoracic reconstruction results in more resource utilization because of its postoperative complications and greater complexity.
-
Comparative Study
Comparison of military and civilian popliteal artery trauma outcomes.
Popliteal artery injury has historically led to high amputation rates in both the military and civilian setting. Military and civilian popliteal injury patterns differ in mechanism and severity of injury, prompting us to compare modern management and report differences in outcomes between these two patient groups. We hypothesized that whereas amputation rates may be higher in the military, this would correlate with worse overall injury severity. ⋯ Although both civilian and military cohorts have high amputation rates for popliteal arterial injury, the rate of amputation appears to be higher in the military and is associated with a penetrating mechanism of injury primarily from improvised explosive devices resulting in a higher MESS and ISS.