Diffusion of new technology for the treatment of renovascular hypertension in the United States: Surgical revascularization versus catheter-based therapy,

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Presentation transcript:

Diffusion of new technology for the treatment of renovascular hypertension in the United States: Surgical revascularization versus catheter-based therapy, 1988-2001 Brian S. Knipp, MD, Justin B. Dimick, MD, Jonathan L. Eliason, MD, John A. Cowan, MD, Peter K. Henke, MD, Mary S. Proctor, MS, James C. Stanley, MD, Gilbert R. Upchurch, MD Journal of Vascular Surgery Volume 40, Issue 4, Pages 717-723 (October 2004) DOI: 10.1016/j.jvs.2004.07.029 Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 1 Cases per year per 100,000 adults. There has been a 46% increase in discharges with a diagnosis code for renovascular hypertension and renal artery atherosclerosis over the study period (P = .0002). Journal of Vascular Surgery 2004 40, 717-723DOI: (10.1016/j.jvs.2004.07.029) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 2 A 73% and 56% decline in combined aortic and renal, as well as isolated renal revascularizations (P = .033 and P < .001) occurred over the 14-year study period. Angioplasty and stenting increased 173% (P < .001). Journal of Vascular Surgery 2004 40, 717-723DOI: (10.1016/j.jvs.2004.07.029) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 3 There was a significant regional variation in rates of percutaneous intervention for revascularization (P < .001). Journal of Vascular Surgery 2004 40, 717-723DOI: (10.1016/j.jvs.2004.07.029) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 4 In hospital mortality versus time. By χ2 analysis, there were no significant variations in mortality over time for any treatment class. Journal of Vascular Surgery 2004 40, 717-723DOI: (10.1016/j.jvs.2004.07.029) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 5 All treatment classes exhibited trends towards decreasing length of stay (P < .001 for all groups). At all time points, combined aortic and renal revascularization had the longest average length of stay, followed by isolated renal revascularization, and then angioplasty and stenting (P < .001). Journal of Vascular Surgery 2004 40, 717-723DOI: (10.1016/j.jvs.2004.07.029) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 6 There were significant regional variations in mean length of stay for patients undergoing aortic and renal reconstruction (P = .009), isolated renal reconstruction (P < .001), and angioplasty and stenting (P = .004). Journal of Vascular Surgery 2004 40, 717-723DOI: (10.1016/j.jvs.2004.07.029) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 7 There were no significant trends in total hospital charges for either combined aortic and renal or isolated renal surgical repairs. Charges for angioplasty and stenting increased significantly (P < .001), approaching charges for isolated surgical renal revascularization. All costs were corrected for 4% annual inflation. Journal of Vascular Surgery 2004 40, 717-723DOI: (10.1016/j.jvs.2004.07.029) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 8 There were significant regional variations in total hospital charges for patients undergoing aortic and renal reconstruction (P = .001), isolated renal reconstruction (P = .017), and angioplasty and stenting (P < .001). Journal of Vascular Surgery 2004 40, 717-723DOI: (10.1016/j.jvs.2004.07.029) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 9 All treatment classes exhibited a significant trend towards increased risk of unfavorable discharge (P = .002 for aortic and renal reconstruction, P = .004 for isolated renal revascularization, and P < .001 for angioplasty and stenting). Journal of Vascular Surgery 2004 40, 717-723DOI: (10.1016/j.jvs.2004.07.029) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 10 There were significant regional variations in the rate of unfavorable discharge for patients undergoing aortic and renal reconstruction (P = .03) and isolated renal reconstruction (P = .007). Journal of Vascular Surgery 2004 40, 717-723DOI: (10.1016/j.jvs.2004.07.029) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions