Procedural Volume and Outcomes in Lower Extremity Peripheral Vascular Interventions: Insights from the National Cardiovascular Data Registry Peripheral Vascular Intervention Registry

Abstract

AbstractBackgroundLower extremity peripheral vascular interventions (PVI) are increasingly utilized for treatment of peripheral artery disease (PAD). However, the relationship between hospital- and operator-volume of PVI with in-hospital major adverse limb events (MALE) and major adverse cardiovascular events (MACE) is not well established.MethodsWe utilized the National Cardiovascular Data Registry PVI registry that included procedural data from 4/1/2014 – 9/3/2020 and assessed in-hospital MALE and MACE during hospitalization for PVI. Generalized linear mixed models were used to assess the volume-outcome relationships after adjustment of relevant covariates.ResultsBetween 2014 to 2020, a total of 60,834 PVI procedures were performed at 97 hospitals by 555 operators. In the adjusted analysis, there was no significant association between tertile of hospital volume and MALE (highest vs lowest-volume: OR 0.89, 95% CI 0.73–1.08, p=0.24) or tertile of hospital-volume and MACE (highest vs lowest-volume: OR 1.26, 95% CI 0.98 – 1.62, p=0.066). Notably, undergoing PVI with high volume operators was associated with lower odds of in-hospital MALE (highest vs lowest-volume: OR 0.72, 95% CI 0.54–0.94, p=0.017). However, no association was observed between operator-volume tertiles and MACE (highest vs lowest-volume: OR 0.71, 95% CI 0.48–1.04, p=0.082).ConclusionsIn contemporary practice, a strong relationship was observed between operator volume and adjusted PVI outcomes. Highest volume operators had lower rates of in-hospital MALE compared with lowest volume operators. However, there was no observed relationship between tertiles of hospital volume of PVI and associated outcomes.Clinical PerspectivesWhat is New?Procedural volume has been defined as a surrogate to define quality of care in many cardiovascular settings.In patients undergoing peripheral vascular intervention, highest volume operators were associated with lower incidence of in-hospital major adverse limb events.However, there was no observed association between hospital volume of peripheral vascular interventions and outcomes.Clinical ImplicationsOperator-volume may be a valuable surrogate to assess peripheral vascular interventions quality across different centers and could potentially outweigh the significance of institutional volume in the context of the procedural safety and outcomes.