Abstract 11450: The Association of Care Fragmentation on Limb Outcomes After Endovascular PAD Procedures Requiring Reintervention

Abstract

Introduction: Several policies exist that incentivize improved care coordination. Reintervention care fragmentation (when a patient requires a reintervention at another facility that is different than the index facility) for peripheral artery disease (PAD) has not been well-characterized. The intent of this work is to explore the frequency, characteristics, and differences in outcomes for patients when a vascular reintervention occurs at a non-index facility. Methods: National cohort of adults over age 65 who underwent an endovascular procedure for PAD within the Vascular Quality Initiative between January 1, 2010 to December 31, 2018 and had subsequent vascular reintervention. Data was linked to Medicare claims and American Hospital Association. We excluded emergency procedures, those performed for aneurysm, and those performed in an office-based setting. The primary outcomes were 90-day and 180-day amputation. Covariates of interest included sociodemographic, anatomic, procedural, and facility-level characteristics. Mixed effect logistic regression models (clustered at the facility-level) were used to determine the association between reintervention at an index versus non-index facility and the outcomes of interest. Results: Among 4,470 patients who underwent a vascular reintervention after an index endovascular procedure for PAD, 18.1% had their reintervention performed at a non-index facility. There were no differences noted by sex or level of community distress among those who went to the index facility versus a non-index facility for their vascular reintervention. Compared to those who had their reintervention at an index facility, vascular reintervention at a non-index facility was associated with significantly higher likelihood of major amputation (90-d amputation: Odds Ratio (OR) 1.61 [95% Confidence Interval (CI) 1.08-2.39]; 180-day amputation: OR 1.75 [95% CI 1.14-2.70]). Conclusions: Care fragmentation for patients who require vascular reintervention after an index endovascular PAD procedure is associated with higher risk of amputation. Additional work is needed to better understand which patients are at greatest risk for care fragmentation and how to better coordinate care in the post-procedural setting.