PMID- 32436810
OWN - NLM
STAT- MEDLINE
DCOM- 20201102
LR  - 20220417
IS  - 1545-1550 (Electronic)
IS  - 1526-6028 (Linking)
VI  - 27
IP  - 5
DP  - 2020 Oct
TI  - Impact of Institutional Volume on Critical In-Hospital Complications Adjusted for 
      Patient- and Limb-Related Characteristics: An Analysis of a Nationwide Japanese 
      Registry of Endovascular Interventions for PAD.
PG  - 739-748
LID - 10.1177/1526602820923118 [doi]
AB  - PURPOSE: To investigate the incidence and clinical predictors, including 
      institutional annual case volume, of critical in-hospital complications after 
      endovascular therapy (EVT) for peripheral artery disease (PAD). MATERIALS AND 
      METHODS: The data were extracted from the nationwide registry of peripheral 
      interventions in Japan [Japanese EVT (J-EVT)] between 2012 and 2017. A total of 
      92,224 EVT cases either for chronic limb-threatening ischemia (CLTI) or 
      intermittent claudication were included in the analysis. The primary outcome 
      measure was critical in-hospital complications, which were defined as a composite 
      of urgent surgery and in-hospital death within 30 days after EVT. The 
      institutional volume was classified into quartiles. The association of 
      institutional volume, as well as baseline characteristics, with the critical 
      in-hospital complications was explored using a multivariable logistic regression 
      model with multiple imputation for missing data. Results are presented as the 
      adjusted odds ratio (OR) with the 95% confidence intervals (CI). RESULTS: The 
      estimated prevalence of critical in-hospital complications was 0.3% (95% CI 0.3% 
      to 0.4%). The following 10 patient- and limb-related characteristics were 
      identified as independent risk factors for critical in-hospital complications: 
      (1) female sex (OR 1.75, 95% CI 1.36 to 2.25), (2) age >/=75 years (OR 1.60, 95% CI 
      1.06 to 2.40), (3) CLTI (OR 2.12, 95% CI 1.47 to 3.05), (4) nonambulatory status 
      (OR 1.66, 95% CI 1.23 to 2.24), (5) regular dialysis (OR 1.35, 95% CI 1.02 to 
      1.77), (6) cerebrovascular disease (OR 1.76, 95% CI 1.33 to 2.33), (7) urgent 
      revascularization (OR 5.10, 95% CI 3.64 to 7.13), (8) aortoiliac TASC II D lesion 
      (OR 3.65, 95% CI 2.51 to 5.33), (9) femoropopliteal TASC II D lesion (OR 1.77, 
      95% CI 1.24 to 2.52), and (10) infrapopliteal TASC D lesion (OR 1.52, 95% CI 1.08 
      to 2.13). In addition, the 4th quartile of the institutional volume (>/=158 
      cases/year), but not the 2nd or 3rd quartile, had a significantly and 
      independently lower risk of critical in-hospital complications than the 1st 
      quartile (OR 0.13, 95% CI 0.07 to 0.23). CONCLUSION: After EVT for symptomatic 
      PAD, 0.3% of the population encountered critical in-hospital complications. A 
      higher institutional volume was significantly associated with a lower risk of 
      critical in-hospital complications.
FAU - Iida, Osamu
AU  - Iida O
AUID- ORCID: 0000-0001-6829-7304
AD  - Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
FAU - Takahara, Mitsuyoshi
AU  - Takahara M
AD  - Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 
      Osaka, Japan.
AD  - Department of Diabetes Care Medicine, Osaka University Graduate School of 
      Medicine, Osaka, Japan.
FAU - Kohsaka, Shun
AU  - Kohsaka S
AD  - Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
FAU - Soga, Yoshimitsu
AU  - Soga Y
AUID- ORCID: 0000-0003-1931-5769
AD  - Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
FAU - Fujihara, Masahiko
AU  - Fujihara M
AUID- ORCID: 0000-0002-7001-9220
AD  - Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan.
FAU - Mano, Toshiaki
AU  - Mano T
AD  - Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
FAU - Shinke, Toshiro
AU  - Shinke T
AD  - Department of Cardiology, Showa University School of Medicine, Tokyo, Japan.
FAU - Amano, Tetsuya
AU  - Amano T
AD  - Department of Cardiology, Aichi Medical University, Nagakute, Japan.
FAU - Ikari, Yuji
AU  - Ikari Y
AD  - Division of Cardiovascular Medicine, Tokai University Hospital, Isehara, 
      Kanagawa, Japan.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
DEP - 20200521
PL  - United States
TA  - J Endovasc Ther
JT  - Journal of endovascular therapy : an official journal of the International 
      Society of Endovascular Specialists
JID - 100896915
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Chronic Disease
MH  - Endovascular Procedures/*adverse effects/mortality
MH  - Female
MH  - Hospital Mortality
MH  - *Hospitals, High-Volume
MH  - *Hospitals, Low-Volume
MH  - Humans
MH  - Intermittent Claudication/diagnostic imaging/mortality/physiopathology/*therapy
MH  - Ischemia/diagnostic imaging/mortality/physiopathology/*therapy
MH  - Japan/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Peripheral Arterial Disease/diagnostic imaging/mortality/physiopathology/*therapy
MH  - Quality Indicators, Health Care
MH  - Registries
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - *Workload
OTO - NOTNLM
OT  - Case volume
OT  - endovascular therapy
OT  - institutional volume
OT  - mortality
OT  - peripheral artery disease
OT  - risk score
EDAT- 2020/05/22 06:00
MHDA- 2020/11/03 06:00
CRDT- 2020/05/22 06:00
PHST- 2020/05/22 06:00 [pubmed]
PHST- 2020/11/03 06:00 [medline]
PHST- 2020/05/22 06:00 [entrez]
AID - 10.1177/1526602820923118 [doi]
PST - ppublish
SO  - J Endovasc Ther. 2020 Oct;27(5):739-748. doi: 10.1177/1526602820923118. Epub 2020 
      May 21.