Anant Mandawat

Endovascular procedures for aorto-iliac occlusive disease are associated with superior short-term clinical and economic outcomes compared with open surgery in the inpatient population

OBJECTIVES There has been a rapid increase in the number of endovascular procedures performed for peripheral artery disease, and especially aorto-iliac occlusive disease (AIOD). Results from single-center reports suggest a benefit for endovascular procedures; however, these benefits may not reflect general practice. We used a population-based analysis to determine predictors of clinical and economic outcomes following open and endovascular procedures for inpatients with AIOD. METHODS All patients with AIOD who underwent open and endovascular procedures in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2004 to 2007, were identified. Independent patient- and provider-related characteristics were analyzed. Clinical outcomes included complications and mortality; economic outcomes included length of stay (LOS) and cost (2007 dollars). Outcomes were compared using χ2, ANOVA, and multivariate regression analysis. RESULTS Four thousand, one hundred nineteen patients with AIOD were identified. Endovascular procedures increased by 18%. Patients who underwent endovascular procedures were more likely to be ≥65 years of age (46% vs 37%), female (54% vs 49%), and in the highest quartile of household income (20% vs 16%), all P<.05. Endovascular patients were more likely to be non-elective (41% vs 20%), in the highest comorbidity index group (8% vs 5%), and with iliac artery disease (67% vs 33%), all P≤.05. In bivariate analysis, endovascular procedures were associated with lower complication rates (16% vs 25%), shorter LOS (2.2 vs 5.8 days), and lower hospital costs (

Safety of Pacemaker Implantation in Nonagenarians An Analysis of the Healthcare Cost and Utilization Project–Nationwide Inpatient Sample

13,661 vs

Endovascular Repair Is Associated With Superior Clinical Outcomes in Patients Transferred for Treatment of Ruptured Abdominal Aortic Aneurysms

17,161), all P<.001. In multivariate analysis, endovascular procedures had significantly lower complication rates and cost, and shorter LOS. CONCLUSIONS Endovascular procedures have superior short-term clinical and economic outcomes compared with open procedures for the treatment of AIOD in the inpatient setting. Further studies are needed to examine long-term outcomes and access-related issues.

Hospitalization rates and in-hospital mortality among centenarians

Background— Data are scarce on outcomes of pacemaker implantation in nonagenarians (age≥90 years). Methods and Results— We identified patients >70 years of age (n=115 683) who underwent initial pacemaker implantation in the 2004 to 2008 Healthcare Cost and Utilization Project–Nationwide Inpatient Sample. Outcomes included in-hospital mortality, complications, length of stay, and charges. Unadjusted outcomes were compared using χ2 and Mantel-Haenszel tests. Multivariate hierarchical logistic models and stepwise linear regression models adjusted for case-mix variation and clustering. Eleven percent (12 917) were >90 years of age. Relative to patients aged 70 to 79 years, patients >90 years of age were more likely to have moderate/severe comorbidity (Charlson score >1; 43.2% versus 40.1%) and less likely to be admitted electively (17.5% versus 29.9%), all P 90 years were 1.87% (CI, 1.63–2.11%) and 6.31% (CI, 5.89–6.72%). Length of stay and charges in patients aged 70 to 79 years were 3.22 days (CI, 3.20–3.24 days) and

Outcome of plasmapheresis in myasthenia gravis: Delayed therapy is not favorable

38 871 (CI,

Age-stratified outcomes in elderly patients undergoing open and endovascular procedures for aortoiliac occlusive disease.

38 700–

Safety of Pacemaker Implantation in NonagenariansClinical Perspective: An Analysis of the Healthcare Cost and Utilization Project–Nationwide Inpatient Sample

39 043), and in patients aged >90 years, 4.27 days (CI, 4.25–4.30 days) and

Safety of Pacemaker Implantation in NonagenariansClinical Perspective

41 373 (CI,

Effect of physician and hospital experience on patient outcomes for endovascular treatment of aortoiliac occlusive disease.

41 190–

Safety of Pacemaker Implantation in Nonagenarians

41 556). Multivariable analysis revealed severe comorbidity (odds ratio, 5.00; 95% CI, 4.05–6.17) was a greater predictor of mortality than increasing age (odds ratio, 2.81 per decade; CI, 2.35–3.35), all P 5) was more strongly associated with complications, length of stay, and charges than age. Conclusions— Although increasing age predicts worsening outcomes in the elderly, the absolute rates are modest, even in nonagenarians, and comorbidity is a stronger predictor. # Clinical Perspective {#article-title-40}Background— Data are scarce on outcomes of pacemaker implantation in nonagenarians (age≥90 years). Methods and Results— We identified patients >70 years of age (n=115 683) who underwent initial pacemaker implantation in the 2004 to 2008 Healthcare Cost and Utilization Project–Nationwide Inpatient Sample. Outcomes included in-hospital mortality, complications, length of stay, and charges. Unadjusted outcomes were compared using &khgr;2 and Mantel-Haenszel tests. Multivariate hierarchical logistic models and stepwise linear regression models adjusted for case-mix variation and clustering. Eleven percent (12 917) were >90 years of age. Relative to patients aged 70 to 79 years, patients >90 years of age were more likely to have moderate/severe comorbidity (Charlson score >1; 43.2% versus 40.1%) and less likely to be admitted electively (17.5% versus 29.9%), all P<0.001. The unadjusted mortality and complication rates in patients aged 70 to 79 years were 0.60% (confidence interval [CI], 0.53–0.67%) and 5.61% (CI, 5.40–5.82%), respectively, and in patients aged >90 years were 1.87% (CI, 1.63–2.11%) and 6.31% (CI, 5.89–6.72%). Length of stay and charges in patients aged 70 to 79 years were 3.22 days (CI, 3.20–3.24 days) and