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1
Statewide Outcomes for Endovascular
Outpatient Interventions
(Becky) Yanyu Long MD
John Blebea MD MBA
Dimitrios Zikos PhD
Department of Surgery
Central Michigan University
22
Disclosures
None
33
Cardio-Vascular Disease
❖Coronary artery disease
❖Peripheral arterial disease
Background
44
https://www.acc.org/latest-in-cardiology/articles/2017/05/31/17/42/the-global-burden-of-
cardiovascular-disease
Coronary Artery Disease
55Fowkes FGR, Rudan D, Rudan I, et al. Lancet. 2013;382(9901):1329-1340.
McDermott MM, Criqui MH. JAMA. 2018;320(2):143..
Peripheral Artery Disease
Globally – 202 million
US – 8.5 million
66
Outpatient setting
Cost reduction
60-75%
Less
pre-op work
No anesthesio
logist
Improved efficiency
and patient satisfaction
Outpatient Procedures
77
Concerns
Safety
Complications Management
88
Complications 0.8%-1.5%
Single center studies
Many are venous procedures
No state level outcomes
Reported Complications
99
Evaluate the safety and cost of
outpatient arterial interventions on a state-wide level
Study Objectives
1010
Michigan State Ambulatory Surgery and
Services Database (SASD) for 2016 which
includes encounter-level data for
ambulatory procedures and other
outpatient services
Clinical and nonclinical information on all
patients, regardless of payer, including
those covered by private insurance,
Medicare, Medicaid, and the uninsured
Methods
1111
Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality
Data elements are coded in a uniform format
Number of episodes in 2016 – 7,992,459
SASD Database
1212
Criteria: CPT codes for endovascular arterial procedures (peripheral, cardiac)
ICD-10 diagnosis codes used to identify procedure-related adverse events
Data Selection
1313
Procedure name CPT codes
Peripheral
angiography/angioplasty
34701-11,34841-8,36011-2,36215-
8,36221-8,36245-8,36251-4,36901-
7,37215-
8,37220,37222,37224,37226,37228,37236
-9,37246-9,70498,70547-9,71275,71555,
72191,72198,74174,75736,73206,73725,7
4174,74175,74185,75635,75726, 75710-
6,75756, 75774,75894,75898,75956-
7,78445, 0254T
Peripheral atherectomy 0234T,0236T,0235T,0237T,0238T,
37225,37227,37229,37231,37233,37235
Coronary
angiography/angioplasty
92920-1,92928-9, 93454-61,93457,93559,
93563-6,93571-2
Coronary
revascularization
stent, atherectomy
92924-5,92937-44
Procedure Codes
1414
Mortality
Complications (ICD-10 diagnosis codes)
Disposition
Cost
Outcomes
1515
Adverse events ICD-10
diagnosis codesHematoma/bleeding T82837, T82838
Thrombosis T82867, T82868
Cardiac (MI, cardiac arrest) I21.0-4 , I22, I46,
Hypotension I95.89, I 95.81
Syncope R00.1 , R55, R55
Seizure R56.9 , F44.5 , G40.909
, R56.00, G40.409,
R56.1
Dyspnea R06.00, F45.8 , R06.4,
R06.02, R06.09,
J45.902, J45.901
Complications of cardiac and vascular
prosthetic devices, implants and grafts
T82***
Unspecified complication of procedure T81***, T88***
Complication Codes
1616
N Age Sex
(Female)
Race
(White)
Peripheral
angio /plasty71,352 58 + 18 56% 78%
Peripheral atherectomy
2,481 69 +11 41.4% 69%
Coronary
angio/ plasty
38,284 65 +12 40% 83%
Coronary
atherectomy
476 66 +11 21% 88%
Patients
1717
34%
28% 28%
8%2%
Metro
(>1 million)
Metro
(250,000 - 1 million)
Metro aja
(2,500-250,000)
Urban
(2,500-250,000)
Rural
(<2,500)
Peripheral Angio / Plasty
1818
58%
14% 15%10% 3%
Metro
(>1 million)
Metro
(250,000 - 1 million)
Metro aja
(2,500-250,000)
Urban
(2,500-250,000)
Rural
(<2,500)
Peripheral Atherectomy
1919
48%
23% 20%
7% 2%
Metro
(>1 million)
Metro
(250,000 - 1 million)
Metro aja
(2,500-250,000)
Urban
(2,500-250,000)
Rural
(<2,500)
Coronary Angio / Plasty
2020
45%
24%20%
10%2%
Metro
(>1 million)
Metro
(250,000 - 1 million)
Metro aja
(2,500-250,000)
Urban
(2,500-250,000)
Rural
(<2,500)
Coronary Atherectomy
2121
76% 79% 81% 78%
24% 21% 19% 22%
PERIPHERAL
ANGIO/PLASTY
PERIPHERAL
ATHERECTOMY
CORONARY
ANGIO/PLASTY
CORONARY
ARTHERECTOMY
Metropolitan area
(population >200,000)
Micropolitan area
(population <200,000)
P=0.000
Geographic Distribution
2222
26%
26%25%
23%
1st Qtr
($1-$42,999)
2nd Qtr
($43,000-$53,999)3rd Qtr
($54,000-$70,999)
4th Qtr
(>$71,000)
Coronary Angio / Plasty
Socioeconomic Status
2323
25%
27%24%
24%
1st Qtr
($1-$42,999)
2nd Qtr
($43,000-$53,999)
3rd Qtr
($54,000-$70,999)
4th Qtr
(>$71,000)
Coronary Atherectomy
2424
32%
28%
23%
17%
1st Qtr
($1-$42,999)
2nd Qtr
($43,000-$53,999)
3rd Qtr
($54,000-$70,999)
4th Qtr
(>$71,000)
Peripheral Angio / Plasty
2525
38%
26%
20%
16%
1st Qtr
($1-$42,999)
2nd Qtr
($43,000-$53,999)
3rd Qtr
($54,000-$70,999)
4th Qtr
(>$71,000)
Peripheral Atherectomy
2626
Mortality
Peripheral angio /plasty 0.1%
Peripheral atherectomy 0%
Coronary angio/ plasty 0.1%
Coronary atherectomy 1.7%
Mortality
2727
Cardiac
(MI)
Hypotension Procedure
related
complications
Peripheral angio
/plasty
0.6% 0.1% 2.1%
Peripheral
atherectomy
0% 0% 2.4%
Coronary angio/
plasty2.2% 0% 3.4%
Coronary
atherectomy
9% 0.2% 7.8%
Complications
2828
86%
88%
90%
92%
94%
96%
98%
100%
Peripheral
angio/plasty
Peripheral
atherectomy
Coronary
angio/plasty
Coronary
atherectomy
HO
ME
P=0.000
Disposition after Procedures
2929
0%
1%
2%
3%
4%
5%
6%
7%
86%
88%
90%
92%
94%
96%
98%
100%
Peripheral
angio/plasty
Peripheral
atherectomy
Coronary
angio/plasty
Coronary
atherectomy
INPA
TIEN
T A
DM
ISSIO
N
HO
ME
P=0.000
Disposition after Procedures
3030
$19,618
$11,435
$0
$5,000
$10,000
$15,000
$20,000
$25,000
Coronary Peripheral
MEA
N C
OST
ANGIO/PLASTY
P=0.000
Charges
3131
$19,618
$11,435 $751
$816
$700
$720
$740
$760
$780
$800
$820
$840
$0
$5,000
$10,000
$15,000
$20,000
$25,000
Coronary Peripheral
STA
TE C
OST
MIL
LIO
NS
MEA
N C
OST
P=0.000
Total Angioplasty Charges
3232
$38,349
$40,910
$25,000
$27,000
$29,000
$31,000
$33,000
$35,000
$37,000
$39,000
$41,000
$43,000
$45,000
Coronary Peripheral
MEA
N C
OST
ATHERECTOMY
P=0.000
Atherectomy Charges
3333
$38,349
$40,910
$18
$101
$0
$20
$40
$60
$80
$100
$120
$37,000
$37,500
$38,000
$38,500
$39,000
$39,500
$40,000
$40,500
$41,000
$41,500
Coronary Peripheral
STA
TE C
OST/
YEA
R
MIL
LIO
NS
MEA
N C
OST
P=0.000
Total Charges
3434
Conclusions
• Outpatient endovascular interventions
are performed with low morbidity
and mortality
• Coronary atherectomy is associated
with the highest mortality and
morbidity
• Hospital admissions are infrequent
• Total costs are significant
35
Thank you!