Perioperative transfusion in vascular surgical patients is independently associated with increased 30-day morbidity and mortality. Given indeterminate causation, these data suggest the need for a prospective transfusion threshold study in vascular surgical patients.
Background: The incidence, risk factors, and outcomes associated with Contrast-induced nephropathy (CIN) after Percutaneous Vascular Intervention (PVI) in contemporary medical practice are largely unknown.Methods: A total of 13 126 patients undergoing PVI were included in the analysis. CIN was defined as an increase in serum creatinine from pre-PVI baseline to post-PVI peak Cr of ≥0.5 mg/dL.Results: CIN occurred in 3% (400 patients) of the cohort, and 26 patients (6.5%) required dialysis.
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ObjectiveTo determine the predictors of periprocedural blood transfusion and the association of transfusion on outcomes in high risk patients undergoing endoluminal percutaneous vascular interventions (PVI) for peripheral arterial disease.Methods/ResultsBetween 2010–2014 at 47 hospitals participating in a statewide quality registry, 4.2% (n = 985) of 23,273 patients received a periprocedural blood transfusion. Transfusion rates varied from 0 to 15% amongst the hospitals in the registry. Using multiple logistic regression, factors associated with increased transfusion included female gender (OR = 1.9; 95% CI: 1.6–2.1), low creatinine clearance (1.3; 1.1–1.6), pre-procedural anemia (4.7; 3.9–5.7), family history of CAD (1.2; 1.1–1.5), CHF (1.4; 1.2–1.6), COPD (1.2; 1.1–1.4), CVD or TIA (1.2; 1.1–1.4), renal failure CRD (1.5; 1.2–1.9), pre-procedural heparin use (1.8; 1.4–2.3), warfarin use (1.2; 1.0–1.5), critical limb ischemia (1.7; 1.5–2.1), aorta-iliac procedure (1.9; 1.5–2.5), below knee procedure (1.3; 1.1–1.5), urgent procedure (1.7; 1.3–2.2), and emergent procedure (8.3; 5.6–12.4). Using inverse weighted propensity matching to adjust for confounders, transfusion was a significant risk factor for death (15.4; 7.5–31), MI (67; 29–150), TIA/stroke (24; 8–73) and ARF (19; 6.2–57). A focused QI program was associated with a 28% decrease in administration of blood transfusion (p = 0.001) over 4 years.ConclusionIn a large statewide PVI registry, post procedure transfusion was highly correlated with a specific set of clinical risk factors, and with in-hospital major morbidity and mortality. However, using a focused QI program, a significant reduction in transfusion is possible.
femoropopliteal (fem-pop) artery disease with drug-coated balloons (DCB) vs. standard PTA. The overall impact of DCB use on medical care costs is unknown. Methods: We performed a prospective economic study alongside the IN.PACT SFA II trial, which randomized patients with symptomatic fem-pop disease to DCB vs. standard PTA and followed them for a minimum of 12 months. Detailed medical resource utilization data were collected and costs were assigned for all US patients using resource-based accounting (for revascularization procedures, medications and outpatient vascular care) and hospital billing data for costs associated with the index and follow-up hospitalizations for treatment of the target limb. The DCB was assigned a cost of $1350/balloon. Results: A total of 181 US patients were enrolled (121 DCB, 60 PTA). Initial hospital costs were approximately $1100/patient higher in the DCB group than the PTA group ($8258 vs. $7164, p< 0.001), driven mainly by the cost of the DCB itself (see Table). From discharge through 12 months, follow-up target-limb related medical care costs were w$750/pt lower in the DCB group, such that total 1-year costs were similar for the 2 groups ($10,034 vs. $9694, p¼0.82) with a resulting incremental cost-effectiveness ratio of $2906 per repeat revascularization avoided -similar to that for coronary drug-eluting stents.Conclusions: For patients with symptomatic fem-pop disease, use of the DCB was associated with higher initial costs compared with standard PTA, but these were largely offset by lower costs for follow-up target limb procedures through 1-year of follow-up. The cost-effectiveness of DCB for such patients appears to compare favorably with that for other cardiovascular interventions.
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