Endovascular experience at an academic office-based procedure center

• Published in: Vascular Vol. 31; no. 2; p. 226
• Main Authors: Malgor, Rafael D, Baker, Jennifer M, Malgor, Emily A, Blebea, John
• Format: Journal Article
• Language: English
• Published: England 01-04-2023
• Subjects: Aged; Endovascular Procedures - adverse effects; Female; Hospitalization; Humans; Male; Medicare; Middle Aged; Retrospective Studies; Risk Factors; Treatment Outcome; United States; United States; Office-based procedure center; endovascular; outcomes; academic; financial
• ISSN: 1708-539X
• DOI: 10.1177/17085381211059651

The number of office-based procedure centers with the capability of performing a wide range of endovascular procedures has substantially increased over the past decade. This shift in practice settings has occurred faster in the private sector as compared to the academic environment. The purpose of our study was to evaluate the clinical outcomes of endovascular procedures performed at a dedicated academic outpatient procedural center.
We reviewed the clinical data of 400 patients who underwent 499 endovascular procedures in a university-based, academic outpatient procedure center between November 2013 and December 2016. Outcomes analyzed included procedure-related complications, limb loss, mortality, and emergency department visits or hospital admissions that occurred within 30 days following the procedure.
The 400 patients had a mean age of 65 ± 13 years with slightly more females (51%;
= 203) as compared to males (49%;
= 197). Most patients (71%; 284) were Caucasian while 80 (20%) were African-Americans. Associated comorbidities included hypertension (86%), diabetes mellitus (51%), chronic kidney disease (42%), and obesity (mean body mass index of 29 ± 6). Based on anesthetic risk, most were ASA class 3 (81%), while ASA 1 and 2 comprised 17% and ASA 4 only 2%. Medicare beneficiaries accounted for 254 (64%) of our patients. Pre-operative studies included mainly duplex ultrasound (62%) and other noninvasive arterial studies (57%).The mean procedural time was 58 min (range, 7 to 200) with an overall technical success rate of 97%. There were no deaths. Complications developed in 10 patients following the 483 procedures (2.1%) being hospitalized with four of them transferred directly to the emergency room. The reasons for these hospitalizations included acute limb ischemia, arterial pseudoaneurysm, deep vein thrombosis, congestive heart failure, myocardial infarction, and lower extremity pain not vascular in origin. Financial reimbursement at the office-based center was higher than that seen with hospital-based procedures.
Endovascular procedures performed in an academic office-based procedure center are safe and associated with good clinical outcomes. A small minority of patients have subsequent ER visits or hospital admissions. Academic institutions should consider adding an office-based procedure center based on today's competitive healthcare market.