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IP223. Interhospital Vascular Surgery Transfers at a Tertiary Care Hospital
JOURNAL OF VASCULAR SURGERY June Supplement 2016
126S Abstracts
demonstrated the IIAA feeding from superior gluteal arteries. Selective embolization of the feeding vessels and the aneurysm sac were performed using a combination of Amplatzer plugs, coils, and intrasac thrombin injection. The percutaneous access was closed using an Amplatzer plug. Results: Completion angiography demonstrated IIAA sac occlusion in both cases. The patient tolerated the procedure without any complication. Fluoroscopy time and contrast use (Visipaque) were 17 and 45 minutes and 50 and 130 mL respectively. The 6-month CT angiography showed complete exclusion of the sac in both cases. The Fig shows the preoperative, intraoperative and postprocedure imaging. Conclusions: Percutaneous transgluteal treatment of IIAAs is a feasible minimally invasive approach when conventional approaches are not feasible due to prior surgical or endovascular occlusion of the internal iliac artery origin.
received no intervention. Small hospitals (<100 beds) were more likely to transfer patients not requiring intervention compared to large hospitals (>300 beds; 47% vs 18%; P ¼ .005), and for infection/nonhealing wounds (30% vs 10%; P ¼ .013). Based on referring hospital size, there was no difference in IHTs requiring emergency, urgent, or nonurgent operations. There was also no difference in transport time, time from consult to arrival, or patient mortality according to hospital size. Overall patient mortality was 17%. Conclusions: Expectedly, most vascular surgery IHTs are for life- or limb-threatening diagnoses, and most of these patients receive an operation. Transfer efficiency and surgical case urgency is similar across hospital sizes. Nonoperative IHTs are sent more often by small hospitals and may represent a resource disparity which would benefit from regionalizing nonurgent vascular care.
Author Disclosures: E. Chisci: Nothing to disclose; M. Citone: Endochoice: speaker’s bureau; E. Mazza: Nothing to disclose; S. Michelagnoli: Nothing to disclose.
Author Disclosures: S. K. Harris: Nothing to disclose; E. Jung: Nothing to disclose; E. L. Mitchell: Nothing to disclose; G .L. Moneta: Nothing to disclose; D. Wilson: Nothing to disclose.
IP223.
IP225.
Interhospital Vascular Surgery Transfers at a Tertiary Care Hospital Sheena K. Harris, MD, Dale Wilson, MD, Enjae Jung, MD, Gregory L. Moneta, MD, Erica L. Mitchell, MD, MEd, SE. Oregon Health & Science University, Portland, Ore
If You Build It, They Will Come!
Objectives: Interhospital transfers (IHT) to tertiary care centers are linked to lower operative mortality in vascular surgery patients. However, IHT incurs great health care costs, and some transfers may be unnecessary or futile. In this study, we characterize the patterns of IHT at a tertiary care center to examine appropriateness of transfer for vascular surgery care. Methods: A retrospective review was performed of all IHT requests made to our institution July 2014 to October 2015. Interhospital physician communication and reasons for not accepting transfers were reviewed. Diagnosis, intervention, referring hospital size, and mortality were examined. Follow-up for all patients was reviewed. Results: A total of 235 IHT requests for vascular surgical care involving 210 patients over 15 months were reviewed. A total of 33% of requested transfers did not occur, most commonly after physician communication resulting in reassurance (35%), clinic referral (30%), or further local workup obviating need for transfer (11%). A total of 67% of requests were accepted. Accepted transfers generally carried life- or limb-threatening diagnoses (70%). Next most common transfer reasons were infection/nonhealing wounds (7%) and nonurgent postoperative complications (7%). A total of 72% of accepted transfers resulted in operative or endovascular intervention: 20% were performed <8 hours of arrival, 12% <24 hours, and 68% during hospital admission (average 3 days). A total of 28% of accepted patients
Adam Tanious, MD1, Marcelo Giarelli, RN2, Murray Shames, MD1. 1University of South Florida, Tampa, Fla; 2 Tampa General Hospital, Tampa, Fla Objectives: In January 2015 we created a multidisciplinary Aortic Center with the collaboration of Vascular Surgery, Cardiac Surgery, and Interventional Radiology. We report the initial success of creating a Comprehensive Aortic Center. Methods: All aortic procedures performed from January 1, 2015, until December 31, 2015, were entered into a prospectively collected database. Data was compared with available data provided by the hospital for 2014. Primary outcomes were number of aortic-related procedures (open abdominal, open ascending/arch, endovascular), transfer acceptance rate, and proportion of elective/emergency referrals. Results: The Aortic Center included 5 vascular surgeons, 2 cardiac surgeons, and 2 interventional radiologists. In 2015, we performed 261 aortic surgeries, 146 endovascular, 65 open abdominal or thoracoabdominal, and 50 ascending aortic repairs a significant increase vs 2014 values (113, 26, and 23, respectively). This reflected an overall 61% (P ¼ .0167) increase in all aortic procedures. The increase was most notable for open abdominal/thoracoabdominal procedures (150%) and ascending aortic repairs (117%). Endovascular case volume increased 29% between the years studied. A similar increase in embolization interventions for endoleaks (26%) was also observed. With regard to our referral pattern, we had a 65% overall increase in transfer request with 156% increase in acceptance of referrals and 136% drop in transfer denials (P < .0001). Emergency abdominal aortic cases accounted for 17% (n ¼ 45) of our total aortic volume in 2015. Sixty-
126S Abstracts
demonstrated the IIAA feeding from superior gluteal arteries. Selective embolization of the feeding vessels and the aneurysm sac were performed using a combination of Amplatzer plugs, coils, and intrasac thrombin injection. The percutaneous access was closed using an Amplatzer plug. Results: Completion angiography demonstrated IIAA sac occlusion in both cases. The patient tolerated the procedure without any complication. Fluoroscopy time and contrast use (Visipaque) were 17 and 45 minutes and 50 and 130 mL respectively. The 6-month CT angiography showed complete exclusion of the sac in both cases. The Fig shows the preoperative, intraoperative and postprocedure imaging. Conclusions: Percutaneous transgluteal treatment of IIAAs is a feasible minimally invasive approach when conventional approaches are not feasible due to prior surgical or endovascular occlusion of the internal iliac artery origin.
received no intervention. Small hospitals (<100 beds) were more likely to transfer patients not requiring intervention compared to large hospitals (>300 beds; 47% vs 18%; P ¼ .005), and for infection/nonhealing wounds (30% vs 10%; P ¼ .013). Based on referring hospital size, there was no difference in IHTs requiring emergency, urgent, or nonurgent operations. There was also no difference in transport time, time from consult to arrival, or patient mortality according to hospital size. Overall patient mortality was 17%. Conclusions: Expectedly, most vascular surgery IHTs are for life- or limb-threatening diagnoses, and most of these patients receive an operation. Transfer efficiency and surgical case urgency is similar across hospital sizes. Nonoperative IHTs are sent more often by small hospitals and may represent a resource disparity which would benefit from regionalizing nonurgent vascular care.
Author Disclosures: E. Chisci: Nothing to disclose; M. Citone: Endochoice: speaker’s bureau; E. Mazza: Nothing to disclose; S. Michelagnoli: Nothing to disclose.
Author Disclosures: S. K. Harris: Nothing to disclose; E. Jung: Nothing to disclose; E. L. Mitchell: Nothing to disclose; G .L. Moneta: Nothing to disclose; D. Wilson: Nothing to disclose.
IP223.
IP225.
Interhospital Vascular Surgery Transfers at a Tertiary Care Hospital Sheena K. Harris, MD, Dale Wilson, MD, Enjae Jung, MD, Gregory L. Moneta, MD, Erica L. Mitchell, MD, MEd, SE. Oregon Health & Science University, Portland, Ore
If You Build It, They Will Come!
Objectives: Interhospital transfers (IHT) to tertiary care centers are linked to lower operative mortality in vascular surgery patients. However, IHT incurs great health care costs, and some transfers may be unnecessary or futile. In this study, we characterize the patterns of IHT at a tertiary care center to examine appropriateness of transfer for vascular surgery care. Methods: A retrospective review was performed of all IHT requests made to our institution July 2014 to October 2015. Interhospital physician communication and reasons for not accepting transfers were reviewed. Diagnosis, intervention, referring hospital size, and mortality were examined. Follow-up for all patients was reviewed. Results: A total of 235 IHT requests for vascular surgical care involving 210 patients over 15 months were reviewed. A total of 33% of requested transfers did not occur, most commonly after physician communication resulting in reassurance (35%), clinic referral (30%), or further local workup obviating need for transfer (11%). A total of 67% of requests were accepted. Accepted transfers generally carried life- or limb-threatening diagnoses (70%). Next most common transfer reasons were infection/nonhealing wounds (7%) and nonurgent postoperative complications (7%). A total of 72% of accepted transfers resulted in operative or endovascular intervention: 20% were performed <8 hours of arrival, 12% <24 hours, and 68% during hospital admission (average 3 days). A total of 28% of accepted patients
Adam Tanious, MD1, Marcelo Giarelli, RN2, Murray Shames, MD1. 1University of South Florida, Tampa, Fla; 2 Tampa General Hospital, Tampa, Fla Objectives: In January 2015 we created a multidisciplinary Aortic Center with the collaboration of Vascular Surgery, Cardiac Surgery, and Interventional Radiology. We report the initial success of creating a Comprehensive Aortic Center. Methods: All aortic procedures performed from January 1, 2015, until December 31, 2015, were entered into a prospectively collected database. Data was compared with available data provided by the hospital for 2014. Primary outcomes were number of aortic-related procedures (open abdominal, open ascending/arch, endovascular), transfer acceptance rate, and proportion of elective/emergency referrals. Results: The Aortic Center included 5 vascular surgeons, 2 cardiac surgeons, and 2 interventional radiologists. In 2015, we performed 261 aortic surgeries, 146 endovascular, 65 open abdominal or thoracoabdominal, and 50 ascending aortic repairs a significant increase vs 2014 values (113, 26, and 23, respectively). This reflected an overall 61% (P ¼ .0167) increase in all aortic procedures. The increase was most notable for open abdominal/thoracoabdominal procedures (150%) and ascending aortic repairs (117%). Endovascular case volume increased 29% between the years studied. A similar increase in embolization interventions for endoleaks (26%) was also observed. With regard to our referral pattern, we had a 65% overall increase in transfer request with 156% increase in acceptance of referrals and 136% drop in transfer denials (P < .0001). Emergency abdominal aortic cases accounted for 17% (n ¼ 45) of our total aortic volume in 2015. Sixty-