Medicare risk-adjusted outcomes in elective major vascular surgery

Surgery. 2018 Oct;164(4):831-838. doi: 10.1016/j.surg.2018.03.025. Epub 2018 Jun 22.

Abstract

Background: Risk-adjusted outcomes of elective major vascular surgery that is inclusive of inpatient and 90-day post-discharge adverse outcomes together have not been well studied.

Methods: We studied 2012-2014 Medicare inpatients who received open aortic procedures, open peripheral vascular procedures, endovascular aortic procedures, and percutaneous angioplasty procedures of the lower extremity for risk-adjusted adverse outcomes of inpatient deaths, 3-sigma prolonged length-of-stay outliers, 90-day post-discharge deaths without readmission, and 90-day post-discharge associated readmissions after excluding unrelated events. Observed and predicted total adverse outcomes for hospitals meeting minimum risk-volume criteria were assessed and hospital-specific z-scores and risk-adjusted adverse outcomes were calculated to compare performance.

Results: The total adverse-outcome rate was 27.8% for open aortic procedures, 31.5% for open peripheral vascular procedures, 19.6% for endovascular aortic procedures, and 36.4% for percutaneous angioplasty procedures. The difference in risk-adjusted adverse-outcome rates between the best- and the poorest-performing deciles were 32.2% for open aortic procedures, 29.5% for open peripheral vascular procedures, 21.5% for endovascular aortic procedures, and 37.1% for percutaneous angioplasty procedures. The 90-day post-discharge deaths and readmissions were the major driver of overall adverse-outcome rates.

Conclusion: The variability in risk-adjusted outcomes among best- and poorest-performing hospitals is over 20% in all major vascular procedures and indicates that a large opportunity exists for improvement in results.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Comorbidity
  • Elective Surgical Procedures / adverse effects*
  • Elective Surgical Procedures / mortality
  • Elective Surgical Procedures / statistics & numerical data*
  • Humans
  • Medicare / statistics & numerical data
  • Risk Adjustment / statistics & numerical data
  • Risk Factors
  • Treatment Outcome
  • United States / epidemiology
  • Vascular Diseases / epidemiology
  • Vascular Diseases / surgery*
  • Vascular Surgical Procedures / adverse effects*
  • Vascular Surgical Procedures / mortality
  • Vascular Surgical Procedures / statistics & numerical data*