FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3193971988> ?p ?o ?g. }

• W3193971988 endingPage "e189" @default.
• W3193971988 startingPage "e188" @default.
• W3193971988 abstract "Reimbursement has long been known to affect aspects of patient care. Although open access has been compensated since 2006, reimbursement of percutaneous access for endovascular aneurysm repair (pEVAR) was implemented in January 2018. Our objective was to understand the practice-pattern effects of Centers for Medicare & Medicaid Services (CMS’s) decision to reimburse percutaneous access when performing EVAR. Using the Vascular Quality Initiative dataset from 2012 to present, we selected patients who had undergone EVAR. Patients were distinguished by access type including unilateral or bilateral percutaneous access for their procedure (pEVAR). Outcomes of EVAR before and after reimbursement approval for pEVAR were compared, stratified by access. Primary end points included rates of pEVAR, in-hospital mortality, length of stay (LOS), and 30-complication rates. Overall, there were 35,824 patients who underwent EVAR for abdominal aortic aneurysm. Of these, 14,572 (41%) underwent bilateral pEVAR. The Fig shows the trend of EVAR vs pEVAR for all years studied. The overall annual rate of increase for pEVAR cases from 2015 to 2018 was 6.0%, 19%, and 2%, whereas the annual rate of percentage increase of pEVAR cases was 9%, 10%, and 11%, respectively. Looking specifically at the years 2017 and 2018 (years before and after reimbursement) there was a significant increase in the percentage of bilateral pEVARs compared with EVARs (65.3% vs 72.3%, P < .001). The Table details the specific demographic and outcome variables between the 2 years. Univariate analysis comparing the year before and after pEVAR reimbursement showed a significant increase in the use of ultrasound-guided access, ruptured EVAR patients, and number of patients considered unfit for open repair. We saw a significant decrease in iliac artery adjunctive methods. There was no difference in the number of patients who underwent unilateral percutaneous access. Regarding outcomes, there was a significant difference in LOS (2.84 vs 2.48, P = .035), with post-reimbursement patients having lower average LOS. There were no significant differences in mortality, postoperative complications, or procedure times between groups. Ten of 649 centers (1.5%) in the registry significantly increased their rate of pEVAR after reimbursement (P < .05). On multivariate regression, patients having pEVAR performed after reimbursement had no difference in outcomes. In conclusion, after reimbursement approval for percutaneous access, the use of bilateral pEVAR increased; however, this increase was in line with previous-year trends of growing pEVAR use. There was an associated significant reduction in LOS, but reimbursement had no significant effect on practice patterns or patient outcomes.TableDemographic and outcome variables broken down by percutaneous endovascular aneurysm repair (pEVAR) reimbursementDemographics2017: Before reimbursement (n = 5850)2018: After reimbursement (n = 5391)P valueBilateral pEVAR3821 (65.3%)3897 (72.3%)<.001Unilateral pEVAR403 (6.9%)382 (7.1%).682Female1097 (18.8%)978 (18.5%).404Age73.2 ± 9.173.1 ± 9.4.631Smoker5017 (85.8%)4675 (86.7%).141Hypertension4790 (82.1%)4497 (83.5%).053IDDM226 (3.9%)232 (4.3%).404History of CAD1199 (20.5%)1186 (22.0%).115CHF759 (12.9%)756 (14.0%).246COPD1918 (32.8%)1795 (33.3%).613ESRD83 (1.4%)75 (1.4%).796Prior AAA Repair127 (2.2%)104 (1.9 %).548Preoperative ASA3704 (63.3%)3570 (66.3%).001Preoperative statin3977 (67.8%)3824 (70.9%).001Preoperative beta-blocker2907 (49.7%)2787 (51.7%).034Maximal AAA diameter5.76 (±1.3)5.72 (±1.2).243Rupture320 (5.5%)342 (6.3%).049Admission to repair time7.7 hours (±37)6.5 hours (±23).310Unfit for open AAA698 (12.1%)711 (13.5%).039General anesthesia5273 (90.1%)4892 (90.4%).274Regional/local anesthesia556 (9.5%)428 (9.1%).470Ultrasound-guided access3538 (60.5%)3710 (68.8%)<.001Iliac artery adjunct245 (4.2%)182 (3.4%).024Failed percutaneous access169 (2.9%)138 (2.7%).285Outcomes In-hospital mortality117 (2%)100 (1.9%).577 Length of stay2.84 days (±12.8)2.48 days (±7.1).035 Overall complication426 (7.3%)358 (6.7%).173 Overall procedure duration124 minutes (±67)121 minutes (±64).053 Respiratory failure82 (1.4%)61 (1.1%).202 Renal failure17 (0.3%)19 (0.4%).566 Myocardial infarction19 (0.3%)25 (0.5%).239 Postoperative stroke18 (0.3%)18 (0.3%).806 Postoperative infection9 (0.2%)3 (0.06%).111 Access site occlusion12 (0.2%)10 (0.2%).814 Access site hematoma51 (0.9%)56 (1.0%).362 Access-related reoperation34 (0.58%)33 (0.61%).558AAA, Abdominal aortic aneurysm; ASA, American Society of Anesthesiologists class; CAD, coronary artery disease; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; ESRD, end-stage renal disease; IDDM, insulin-dependent diabetes mellitus.Boldface P values represent statistical significance. Open table in a new tab" @default.
• W3193971988 created "2021-08-30" @default.
• W3193971988 creator A5004576347 @default.
• W3193971988 creator A5016859429 @default.
• W3193971988 creator A5031376970 @default.
• W3193971988 creator A5031439299 @default.
• W3193971988 creator A5055611097 @default.
• W3193971988 creator A5063394608 @default.
• W3193971988 creator A5073880360 @default.
• W3193971988 creator A5076017996 @default.
• W3193971988 date "2021-09-01" @default.
• W3193971988 modified "2023-09-23" @default.
• W3193971988 title "Practice Patterns of Percutaneous EVAR After Reimbursement Reform" @default.
• W3193971988 doi "https://doi.org/10.1016/j.jvs.2021.06.281" @default.
• W3193971988 hasPublicationYear "2021" @default.
• W3193971988 type Work @default.
• W3193971988 sameAs 3193971988 @default.
• W3193971988 citedByCount "0" @default.
• W3193971988 crossrefType "journal-article" @default.
• W3193971988 hasAuthorship W3193971988A5004576347 @default.
• W3193971988 hasAuthorship W3193971988A5016859429 @default.
• W3193971988 hasAuthorship W3193971988A5031376970 @default.
• W3193971988 hasAuthorship W3193971988A5031439299 @default.
• W3193971988 hasAuthorship W3193971988A5055611097 @default.
• W3193971988 hasAuthorship W3193971988A5063394608 @default.
• W3193971988 hasAuthorship W3193971988A5073880360 @default.
• W3193971988 hasAuthorship W3193971988A5076017996 @default.
• W3193971988 hasBestOaLocation W31939719881 @default.
• W3193971988 hasConcept C141071460 @default.
• W3193971988 hasConcept C160735492 @default.
• W3193971988 hasConcept C162324750 @default.
• W3193971988 hasConcept C2776098176 @default.
• W3193971988 hasConcept C2776534028 @default.
• W3193971988 hasConcept C2776543907 @default.
• W3193971988 hasConcept C2779703844 @default.
• W3193971988 hasConcept C2779993416 @default.
• W3193971988 hasConcept C2780813298 @default.
• W3193971988 hasConcept C50522688 @default.
• W3193971988 hasConcept C71924100 @default.
• W3193971988 hasConceptScore W3193971988C141071460 @default.
• W3193971988 hasConceptScore W3193971988C160735492 @default.
• W3193971988 hasConceptScore W3193971988C162324750 @default.
• W3193971988 hasConceptScore W3193971988C2776098176 @default.
• W3193971988 hasConceptScore W3193971988C2776534028 @default.
• W3193971988 hasConceptScore W3193971988C2776543907 @default.
• W3193971988 hasConceptScore W3193971988C2779703844 @default.
• W3193971988 hasConceptScore W3193971988C2779993416 @default.
• W3193971988 hasConceptScore W3193971988C2780813298 @default.
• W3193971988 hasConceptScore W3193971988C50522688 @default.
• W3193971988 hasConceptScore W3193971988C71924100 @default.
• W3193971988 hasIssue "3" @default.
• W3193971988 hasLocation W31939719881 @default.
• W3193971988 hasOpenAccess W3193971988 @default.
• W3193971988 hasPrimaryLocation W31939719881 @default.
• W3193971988 hasRelatedWork W1996097135 @default.
• W3193971988 hasRelatedWork W2061253854 @default.
• W3193971988 hasRelatedWork W2119172533 @default.
• W3193971988 hasRelatedWork W2330404122 @default.
• W3193971988 hasRelatedWork W2621294089 @default.
• W3193971988 hasRelatedWork W2947783996 @default.
• W3193971988 hasRelatedWork W2951555197 @default.
• W3193971988 hasRelatedWork W3037686638 @default.
• W3193971988 hasRelatedWork W4252135025 @default.
• W3193971988 hasRelatedWork W4379375601 @default.
• W3193971988 hasVolume "74" @default.
• W3193971988 isParatext "false" @default.
• W3193971988 isRetracted "false" @default.
• W3193971988 magId "3193971988" @default.
• W3193971988 workType "article" @default.