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Vascular Surgeons Have Better Outcomes than Non-Vascular Surgeons in Key Index Open Vascular Procedure
Moreira, Carla1; Rybin, Denis2; Doros, Gheorghe2; Kalish, Jeffrey1; Eslami, Mohammad H1; Farber, Alik1
1Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA; 2Department of Biostatistics, Boston University, Boston, MA

Background: The purpose of this study was to determine the impact of surgeon specialty on outcome after carotid endarterectomy (CEA), lower extremity bypass (LEB), and open abdominal aortic aneurysm repair (AAA).

Methods:The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset (2005-2011) was queried to identify patients who underwent open AAA, LEB, and CEA. Stratification by surgeon specialty was performed to analyze the primary endpoint: in-hospital mortality. After adjusting for patient characteristics, multivariable logistic regression models were used to evaluate the association of surgeon specialty with mortality, stroke, myocardial infarction (MI), and other complications.

Results: The analysis included 85,054 procedures. Patients undergoing open AAA repair by vascular surgeons had significantly lower in-hospital mortality than those treated by non-vascular surgeons (8% vs. 11.2%; p=0.005). A similar trend was noted for CEA (0.7% vs. 1%; p=0.119) and LEB (2.3% vs. 2.5%; p=0.601). Multivariable models of AAA repair showed decreased odds of mortality (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.51-0.91, p=0.009), mortality/stroke/MI (OR 0.64, 95% CI 0.49-0.83, p=0.001), and unplanned return to the operating room (OR 0.73, 95% CI 0.57-0.93, p=0.013) when performed by vascular surgeons. CEA performed by vascular surgeons had significantly lower odds of stroke (OR 0.68, 95% CI 0.50-0.92, p=0.012), mortality/stroke (OR 0.67, 95% CI 0.52-0.87, p=0.003), mortality/stroke/MI (OR 0.75, 95% CI 0.59-0.96, p=0.02), and overall complications (OR 0.70, 95% CI 0.57-0.86, p=0.001). Surgeon specialty had no significant effect on LEB outcomes.

Conclusion: In relation to common morbidities and overall mortality, vascular surgeons have better outcomes than non-vascular surgeons for open AAA and CEA. Hospitals should consider evaluating and utilizing this specialty-specific information to identify potential quality improvement initiatives.

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