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December 23, 2005
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Toshifumi Kudo, MD, PhD, Woo-Hyung Kwun, MD, PhD, Fiona A. Chandra, Samuel S. Ahn, MD.
UCLA, Los Angeles, CA, USA.
OBJECTIVE: To examine the pattern of catheter-based endovascular procedures (Endo group) compared to open peripheral vascular operations (Open group) performed over 7 years nationally.
METHODS: The numbers of vascular principal procedures performed from 1997 to 2003 were obtained from the Healthcare Cost and Utilization Project Trend Query web site (HCUPnet) database under Single-Level Clinical Classification System (CCS) categories 51 to 63 in Major Procedure Category 7, Procedures on Cardiovascular System. Gender, age category, inhospital mortality, and hospital bill in each CCS category were also obtained from HCUPnet database. Patients in age 17 or less were excluded from the analysis.
RESULTS: A total of 6.7 million procedures were analyzed. The number of vascular procedures have risen from 0.8M in 1997 to 1.1M in 2003 (+32%). In contrast to the rapid rise of the Endo group (200K in 1997 to 415K in 2003, +108%), the number of open surgery (peripheral bypass, carotid endarterectomy, plus aortic aneurysmectomy) has declined (320K in 1997 to 260K in 2003, -19%). The inflection point was in 2001. Amputation ratio (-43%), inhospital mortality rate (-13%), and hospital stay (-5%) have declined from 1997 to 2003. Bypass surgery group had more male patients (57%), while there were more females (57%) in the Endo group. For bypass surgery, the number of patients in each age category has slightly declined (-8% to -13%), except for the largest population age group 65-84, which had continuous and significant reduction (78K in 1997 to 54K in 2003, -30%). The mean hospital charge has increased in each procedure ($21K in 1997 to $33K in 2003 in Endo, +58%; $25K in 1997 to $46K in 2003 in Open, +79%).
CONCLUSIONS: Our analysis shows that the contribution of catheter-based endovascular procedures to peripheral vascular disease has been increasing, while standard open surgeries are declining. This trend is the most obvious in the age category of 65-84. These changes correlate with decreasing mortality rate, amputation rate, and hospital stay.
APPENDIX: Clinical Classification System (CCS) categories in the Healthcare Cost and Utilization Project Trend Query web site database
CCS 51; endarterectomy, vessels of head and neck
CCS 52; aortic resection, replacement or anastomosis
CCS 53; varicose vein stripping, lower limb
CCS 54; other vascular catheterization, not heart
CCS 55; peripheral vascular bypass
CCS 56; other vascular bypass and shunt, not heart
CCS 57; creation, revision and removal of arteriovenous fistula or vessel-to-vessel cannula for dialysis
CCS 59; other operating room procedures on vessels of head and neck
CCS 60; embolectomy and endarterectomy of lower limbs
CCS 61; other operating room procedures on vessels other than head and neck
CCS 63; other non-operating room therapeutic cardiovascular procedures
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Trend in Procedures for Peripheral Vascular Disease: 7-Year Nationwide Statistics
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Toshifumi Kudo, MD, PhD, Woo-Hyung Kwun, MD, PhD, Fiona A. Chandra, Samuel S. Ahn, MD.
UCLA, Los Angeles, CA, USA.
OBJECTIVE: To examine the pattern of catheter-based endovascular procedures (Endo group) compared to open peripheral vascular operations (Open group) performed over 7 years nationally.
METHODS: The numbers of vascular principal procedures performed from 1997 to 2003 were obtained from the Healthcare Cost and Utilization Project Trend Query web site (HCUPnet) database under Single-Level Clinical Classification System (CCS) categories 51 to 63 in Major Procedure Category 7, Procedures on Cardiovascular System. Gender, age category, inhospital mortality, and hospital bill in each CCS category were also obtained from HCUPnet database. Patients in age 17 or less were excluded from the analysis.
RESULTS: A total of 6.7 million procedures were analyzed. The number of vascular procedures have risen from 0.8M in 1997 to 1.1M in 2003 (+32%). In contrast to the rapid rise of the Endo group (200K in 1997 to 415K in 2003, +108%), the number of open surgery (peripheral bypass, carotid endarterectomy, plus aortic aneurysmectomy) has declined (320K in 1997 to 260K in 2003, -19%). The inflection point was in 2001. Amputation ratio (-43%), inhospital mortality rate (-13%), and hospital stay (-5%) have declined from 1997 to 2003. Bypass surgery group had more male patients (57%), while there were more females (57%) in the Endo group. For bypass surgery, the number of patients in each age category has slightly declined (-8% to -13%), except for the largest population age group 65-84, which had continuous and significant reduction (78K in 1997 to 54K in 2003, -30%). The mean hospital charge has increased in each procedure ($21K in 1997 to $33K in 2003 in Endo, +58%; $25K in 1997 to $46K in 2003 in Open, +79%).
CONCLUSIONS: Our analysis shows that the contribution of catheter-based endovascular procedures to peripheral vascular disease has been increasing, while standard open surgeries are declining. This trend is the most obvious in the age category of 65-84. These changes correlate with decreasing mortality rate, amputation rate, and hospital stay.
APPENDIX: Clinical Classification System (CCS) categories in the Healthcare Cost and Utilization Project Trend Query web site database
CCS 51; endarterectomy, vessels of head and neck
CCS 52; aortic resection, replacement or anastomosis
CCS 53; varicose vein stripping, lower limb
CCS 54; other vascular catheterization, not heart
CCS 55; peripheral vascular bypass
CCS 56; other vascular bypass and shunt, not heart
CCS 57; creation, revision and removal of arteriovenous fistula or vessel-to-vessel cannula for dialysis
CCS 59; other operating room procedures on vessels of head and neck
CCS 60; embolectomy and endarterectomy of lower limbs
CCS 61; other operating room procedures on vessels other than head and neck
CCS 63; other non-operating room therapeutic cardiovascular procedures
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