statewide outcomes for endovascular outpatient interventions · 2019-04-25 · cardio-vascular...

1

Statewide Outcomes for Endovascular

Outpatient Interventions

(Becky) Yanyu Long MD

John Blebea MD MBA

Dimitrios Zikos PhD

Department of Surgery

Central Michigan University

22

Disclosures

None

33

Cardio-Vascular Disease

❖Coronary artery disease

❖Peripheral arterial disease

Background

44

https://www.acc.org/latest-in-cardiology/articles/2017/05/31/17/42/the-global-burden-of-

cardiovascular-disease

Coronary Artery Disease

55Fowkes FGR, Rudan D, Rudan I, et al. Lancet. 2013;382(9901):1329-1340.

McDermott MM, Criqui MH. JAMA. 2018;320(2):143..

Peripheral Artery Disease

Globally – 202 million

US – 8.5 million

66

Outpatient setting

Cost reduction

60-75%

Less

pre-op work

No anesthesio

logist

Improved efficiency

and patient satisfaction

Outpatient Procedures

77

Concerns

Safety

Complications Management

88

Complications 0.8%-1.5%

Single center studies

Many are venous procedures

No state level outcomes

Reported Complications

99

Evaluate the safety and cost of

outpatient arterial interventions on a state-wide level

Study Objectives

1010

Michigan State Ambulatory Surgery and

Services Database (SASD) for 2016 which

includes encounter-level data for

ambulatory procedures and other

outpatient services

Clinical and nonclinical information on all

patients, regardless of payer, including

those covered by private insurance,

Medicare, Medicaid, and the uninsured

Methods

1111

Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality

Data elements are coded in a uniform format

Number of episodes in 2016 – 7,992,459

SASD Database

1212

Criteria: CPT codes for endovascular arterial procedures (peripheral, cardiac)

ICD-10 diagnosis codes used to identify procedure-related adverse events

Data Selection

1313

Procedure name CPT codes

Peripheral

angiography/angioplasty

34701-11,34841-8,36011-2,36215-

8,36221-8,36245-8,36251-4,36901-

7,37215-

8,37220,37222,37224,37226,37228,37236

-9,37246-9,70498,70547-9,71275,71555,

72191,72198,74174,75736,73206,73725,7

4174,74175,74185,75635,75726, 75710-

6,75756, 75774,75894,75898,75956-

7,78445, 0254T

Peripheral atherectomy 0234T,0236T,0235T,0237T,0238T,

37225,37227,37229,37231,37233,37235

Coronary

angiography/angioplasty

92920-1,92928-9, 93454-61,93457,93559,

93563-6,93571-2

Coronary

revascularization

stent, atherectomy

92924-5,92937-44

Procedure Codes

1414

Mortality

Complications (ICD-10 diagnosis codes)

Disposition

Cost

Outcomes

1515

Adverse events ICD-10

diagnosis codesHematoma/bleeding T82837, T82838

Thrombosis T82867, T82868

Cardiac (MI, cardiac arrest) I21.0-4 , I22, I46,

Hypotension I95.89, I 95.81

Syncope R00.1 , R55, R55

Seizure R56.9 , F44.5 , G40.909

, R56.00, G40.409,

R56.1

Dyspnea R06.00, F45.8 , R06.4,

R06.02, R06.09,

J45.902, J45.901

Complications of cardiac and vascular

prosthetic devices, implants and grafts

T82***

Unspecified complication of procedure T81***, T88***

Complication Codes

1616

N Age Sex

(Female)

Race

(White)

Peripheral

angio /plasty71,352 58 + 18 56% 78%

Peripheral atherectomy

2,481 69 +11 41.4% 69%

Coronary

angio/ plasty

38,284 65 +12 40% 83%

Coronary

atherectomy

476 66 +11 21% 88%

Patients

1717

34%

28% 28%

8%2%

Metro

(>1 million)

Metro

(250,000 - 1 million)

Metro aja

(2,500-250,000)

Urban

(2,500-250,000)

Rural

(<2,500)

Peripheral Angio / Plasty

1818

58%

14% 15%10% 3%

Metro

(>1 million)

Metro

(250,000 - 1 million)

Metro aja

(2,500-250,000)

Urban

(2,500-250,000)

Rural

(<2,500)

Peripheral Atherectomy

1919

48%

23% 20%

7% 2%

Metro

(>1 million)

Metro

(250,000 - 1 million)

Metro aja

(2,500-250,000)

Urban

(2,500-250,000)

Rural

(<2,500)

Coronary Angio / Plasty

2020

45%

24%20%

10%2%

Metro

(>1 million)

Metro

(250,000 - 1 million)

Metro aja

(2,500-250,000)

Urban

(2,500-250,000)

Rural

(<2,500)

Coronary Atherectomy

2121

76% 79% 81% 78%

24% 21% 19% 22%

PERIPHERAL

ANGIO/PLASTY

PERIPHERAL

ATHERECTOMY

CORONARY

ANGIO/PLASTY

CORONARY

ARTHERECTOMY

Metropolitan area

(population >200,000)

Micropolitan area

(population <200,000)

P=0.000

Geographic Distribution

2222

26%

26%25%

23%

1st Qtr

($1-$42,999)

2nd Qtr

($43,000-$53,999)3rd Qtr

($54,000-$70,999)

4th Qtr

(>$71,000)

Coronary Angio / Plasty

Socioeconomic Status

2323

25%

27%24%

24%

1st Qtr

($1-$42,999)

2nd Qtr

($43,000-$53,999)

3rd Qtr

($54,000-$70,999)

4th Qtr

(>$71,000)

Coronary Atherectomy

2424

32%

28%

23%

17%

1st Qtr

($1-$42,999)

2nd Qtr

($43,000-$53,999)

3rd Qtr

($54,000-$70,999)

4th Qtr

(>$71,000)

Peripheral Angio / Plasty

2525

38%

26%

20%

16%

1st Qtr

($1-$42,999)

2nd Qtr

($43,000-$53,999)

3rd Qtr

($54,000-$70,999)

4th Qtr

(>$71,000)

Peripheral Atherectomy

2626

Mortality

Peripheral angio /plasty 0.1%

Peripheral atherectomy 0%

Coronary angio/ plasty 0.1%

Coronary atherectomy 1.7%

Mortality

2727

Cardiac

(MI)

Hypotension Procedure

related

complications

Peripheral angio

/plasty

0.6% 0.1% 2.1%

Peripheral

atherectomy

0% 0% 2.4%

Coronary angio/

plasty2.2% 0% 3.4%

Coronary

atherectomy

9% 0.2% 7.8%

Complications

2828

86%

88%

90%

92%

94%

96%

98%

100%

Peripheral

angio/plasty

Peripheral

atherectomy

Coronary

angio/plasty

Coronary

atherectomy

HO

ME

P=0.000

Disposition after Procedures

2929

0%

1%

2%

3%

4%

5%

6%

7%

86%

88%

90%

92%

94%

96%

98%

100%

Peripheral

angio/plasty

Peripheral

atherectomy

Coronary

angio/plasty

Coronary

atherectomy

INPA

TIEN

T A

DM

ISSIO

N

HO

ME

P=0.000

Disposition after Procedures

3030

$19,618

$11,435

$0

$5,000

$10,000

$15,000

$20,000

$25,000

Coronary Peripheral

MEA

N C

OST

ANGIO/PLASTY

P=0.000

Charges

3131

$19,618

$11,435 $751

$816

$700

$720

$740

$760

$780

$800

$820

$840

$0

$5,000

$10,000

$15,000

$20,000

$25,000

Coronary Peripheral

STA

TE C

OST

MIL

LIO

NS

MEA

N C

OST

P=0.000

Total Angioplasty Charges

3232

$38,349

$40,910

$25,000

$27,000

$29,000

$31,000

$33,000

$35,000

$37,000

$39,000

$41,000

$43,000

$45,000

Coronary Peripheral

MEA

N C

OST

ATHERECTOMY

P=0.000

Atherectomy Charges

3333

$38,349

$40,910

$18

$101

$0

$20

$40

$60

$80

$100

$120

$37,000

$37,500

$38,000

$38,500

$39,000

$39,500

$40,000

$40,500

$41,000

$41,500

Coronary Peripheral

STA

TE C

OST/

YEA

R

MIL

LIO

NS

MEA

N C

OST

P=0.000

Total Charges

3434

Conclusions

• Outpatient endovascular interventions

are performed with low morbidity

and mortality

• Coronary atherectomy is associated

with the highest mortality and

morbidity

• Hospital admissions are infrequent

• Total costs are significant

35

Thank you!