Treatment outcomes and lessons learned from 5134 cases of outpatient office-based endovascular procedures in a vascular surgical practice

Abstract

Introduction The office-based endovascular facility has increased in number recently due in part to expedient patient experience. This study analyzed treatment outcomes of procedures performed in our office-based endovascular suite. Methods Treatment outcomes of 5134 consecutive procedures performed in our office-based endovascular suites from 2006 to 2013 were analyzed. Five sequential groups (group I-V) of 1000 consecutive interventions were compared with regard to technical success and treatment outcomes. Results Our patients included 2856 (56%) females and 2267 (44%) males. Procedures performed included diagnostic arteriogram, arterial interventions, venous interventions, dialysis access interventions, and venous catheter management, which were 1024 (19.9%), 1568 (30.6%), and 3073 (60.0%), 621(12.1%), and 354 (6.9%), respectively. The complication rates for group I, II, III, IV, and V were 3%, 1.5%, 1%, 1.1%, and 0.7%, respectively. The complication rate was higher in group I when compared to each of the remaining four groups ( p < 0.05). Nine patients (0.18%) died within the 30-day period following their procedures, and none were procedure related. Conclusions Endovascular procedure can be performed safely in an office-based facility with excellent outcomes. Lessons learned in establishing office-based endovascular suites with efforts to reduce procedural complications and optimize quality patient care are discussed.

Clinical Outcomes of Ambulatory Endovascular Treatment Using 4-French and 6-French Femoral Access Strategies: The Bio4amb Multicentre Trial

“…However, the outcomes were nearly identical in the groups (2.8% vs. 3.2%), as the 6F group had better outcomes than the predicted 5% ASC-rate. This is likely due to improvements in VCDs, the recommended ultrasound guidance, and the fact that participating centres were experienced high-volume centres [19,20]. Thus, the study hypothesis failed slightly (p non-inferiority = 0.0253 instead of \ 0.025) as the sample size was too low being based on a 2% margin of an expected ASC rate of 5% in the 6F group, which turned out to be lower than expected.…”

Preliminary Results of the Outpatient Endovascular and Interventional Society National Registry

“…The preliminary data shows safe results, which supports and validates previous single-center results. 4,6 These results will continue to be analyzed and reported in future publications.…”

“…6 This increased utilization of outpatient and office-based sites of service has raised questions about potential overutilization, adverse patient outcomes, and the overall quality of care provided in this environment. [7][8][9] Though published reports from individual centers have shown excellent clinical results with very low morbidity and mortality, 4,6,10 there is little statewide or national data available for analysis and comparison. Similarly, there are no established guidelines or metrics from which to assess best clinical practices.…”

Commentary: The OEIS National Registry Has the Potential to Change Office-Based Endovascular Practice: Is That a Cause for Celebration or Trepidation?

“…Office-based laboratories (OBL) or office-based endovascular interventional suites offer distinct advantages over the hospital setting, including the ability to provide high-quality care in both a time-and cost-efficient manner, combined with the added benefit of very high patient satisfaction. [1][2][3][4] As more and more procedures are being transitioned out of the traditional hospital setting into the outpatient setting, the move has raised some criticism as well as legitimate questions. These concerns range from the pervasive opinion that OBLs are simply in it for financial gain, with minimal regard for patient outcomes (ie, the increase in atherectomy usage due to reimbursement rates rather than indications), 5,6 to other important questions such as OBL patient selection.…”

“…There are many studies showing good outcomes, with low morbidity and mortality, in an outpatient setting. [1][2][3][4]7 One such study, 3 which compares outpatient tibial artery procedures between an office endovascular center and a hospital angiography suite, found lower unplanned admission rates and better patency in the outpatient setting despite similar demographics and baseline Rutherford category.…”