Title: Nationwide Trends in Hospital Outcomes and Utilization After Lower Limb Revascularization in Patients on Hemodialysis.

Authors: Garimella, Pranav S; Balakrishnan, Poojitha; Correa, Ashish; Poojary, Priti; Annapureddy, Narender; Chauhan, Kinsuk; Patel, Achint; Patel, Shanti; Konstantinidis, Ioannis; Chan, Lili; Agarwal, Shiv Kumar; Jaar, Bernard G; Gidwani, Umesh; Matsushita, Kunihiro; Nadkarni, Girish N

Published In JACC Cardiovasc Interv, (2017 Oct 23)

Abstract: This study aimed to describe the temporal trends and outcomes of endovascular and surgical revascularization in a large, nationally representative sample of patients with end-stage renal disease on hemodialysis hospitalized for peripheral artery disease (PAD).PAD is prevalent among patients with end-stage renal disease on hemodialysis and is associated with significant morbidity and mortality. There is a paucity of information on trends in endovascular and surgical revascularization and post-procedure outcomes in this population.We used the Nationwide Inpatient Sample (2002 to 2012) to identify hemodialysis patients undergoing endovascular or surgical procedures for PAD using diagnostic and procedural codes. We compared trends in amputation, post-procedure complications, mortality, length of stay, and costs between the 2 groups using trend tests and logistic regression.There were 77,049 endovascular and 29,556 surgical procedures for PAD in hemodialysis patients. Trend analysis showed that endovascular procedures increased by nearly 3-fold, whereas there was a reciprocal decrease in surgical revascularization. Post-procedure complication rates were relatively stable in persons undergoing endovascular procedures but nearly doubled in those undergoing surgery. Surgery was associated with 1.8 times adjusted odds (95% confidence interval: 1.60 to 2.02) for complications and 1.6 times the adjusted odds for amputations (95% confidence interval: 1.40 to 1.75) but had similar mortality (adjusted odds ratio: 1.05; 95% confidence interval: 0.85 to 1.29) compared with endovascular procedures. Length of stay for endovascular procedures remained stable, whereas a decrease was seen for surgical procedures. Overall costs increased marginally for both procedures.Rates of endovascular procedures have increased, whereas those of surgeries have decreased. Surgical revascularization is associated with higher odds of overall complications. Further prospective studies and clinical trials are required to analyze the relationship between the severity of PAD and the revascularization strategy chosen.

PubMed ID: 29050629

MeSH Terms: Aged; Amputation, Surgical/trends; Chi-Square Distribution; Databases, Factual; Endovascular Procedures/economics; Endovascular Procedures/mortality; Endovascular Procedures/statistics & numerical data; Endovascular Procedures/trends*; Female; Hospital Costs; Hospital Mortality/trends; Hospitalization/economics; Hospitalization/trends*; Humans; Kidney Failure, Chronic/diagnosis; Kidney Failure, Chronic/economics; Kidney Failure, Chronic/mortality; Kidney Failure, Chronic/therapy*; Length of Stay/trends; Limb Salvage/trends; Logistic Models; Lower Extremity/blood supply*; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Peripheral Arterial Disease/diagnosis; Peripheral Arterial Disease/economics; Peripheral Arterial Disease/mortality; Peripheral Arterial Disease/therapy*; Practice Patterns, Physicians'/economics; Practice Patterns, Physicians'/trends*; Process Assessment, Health Care/economics; Process Assessment, Health Care/trends*; Renal Dialysis/economics; Renal Dialysis/mortality; Renal Dialysis/statistics & numerical data; Renal Dialysis/trends*; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; United States/epidemiology; Vascular Surgical Procedures/economics; Vascular Surgical Procedures/mortality; Vascular Surgical Procedures/statistics & numerical data; Vascular Surgical Procedures/trends*