"Identifying Potentially Avoidable Femoral to Popliteal ePTFE Bypass fo" by Ryan Howard, Jeremy Albright et al.
 

Identifying Potentially Avoidable Femoral to Popliteal ePTFE Bypass for Claudication Using Cross Site Blinded Peer Review.

Document Type

Article

Publication Date

2-1-2023

Publication Title

Journal of vascular surgery

Abstract

OBJECTIVE: The surgical treatment of claudication can be associated with significant morbidity and cost. There are growing concerns that some patients proceed to interventions without first attempting evidence-based nonoperative management. We employed direct, cross-site, blinded expert review to evaluate the appropriateness of the surgical treatment of claudication.

METHODS: We enlisted practicing vascular surgeons to perform retrospective clinical assessments of lower extremity bypass procedures in a statewide clinical registry. Cases were limited to elective, open, infrainguinal bypasses performed for claudication using prosthetic grafts. Reviewing surgeons were randomly assigned 10 cases from a sample of 139 anonymized bypass operations and instructed to evaluate procedural appropriateness based on their expert opinion and evidence-based guidelines for preoperative treatment, namely, antiplatelet, statin, cilostazol, exercise, and smoking cessation therapy as documented in the medical record. Ninety-day episode payments were estimated from a distinct but similar cohort of patients undergoing lower extremity bypass for claudication.

RESULTS: Out of 325 total reviews, surgeons stated they would not have recommended bypass in 134 (41%) reviews and deemed bypass inappropriate in 122 (38%) reviews. The most common reason for inappropriateness was lack of preoperative medical and lifestyle therapy, which was present in 63% of reviews where bypass was deemed appropriate and 39% of reviews where bypass was deemed inappropriate (P

CONCLUSIONS: In this cross-site expert peer review study, 40% of lower extremity bypasses were deemed premature and therefore potentially avoidable, primarily due to lack of medical and lifestyle management before surgery. Reviews deemed inappropriate were associated with approximately $4 million in potentially avoidable costs. This approach could inform performance feedback among surgeons to help align clinical practice with evidence-based recommendations for the treatment of claudication.

Volume

77

Issue

2

First Page

490

Last Page

496

DOI

10.1016/j.jvs.2022.09.005

ISSN

1097-6809

PubMed ID

36113823

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