Observatoire Régional de La Santé, 19 Avenue Charles Tillon, 35000, Rennes, Bretagne, France.
Department of Vascular and Endovascular Surgery, Groupe Hospitalier Paris St Joseph, 75014, Paris, France.
Cardiovasc Intervent Radiol. 2022 Oct;45(10):1441-1450. doi: 10.1007/s00270-022-03193-0. Epub 2022 Jun 22.
To compare the safety of outpatient versus inpatient endovascular treatment of lower extremity arterial disease (LEAD) using real-life data.
This retrospective observational study used real-life data from the French national health data information system on adult patients who underwent stenting for LEAD between 2013 and 2016. The outcomes of interest were all-cause mortality, all-cause hospitalization, planned hospitalization, and unplanned hospitalization at day 3 and day 30 after the index endovascular intervention for LEAD revascularization. A propensity score was used to control for indication bias. Outcome rates in outpatient and inpatient settings were compared with the Poisson regression model. Sensitivity analyses were performed by varying the definition of the outcomes of interest.
During the study period, 26,715 interventions were performed among which 2819 (10.6%) were in outpatient settings. Outpatients were slightly younger than inpatients (64.73 ± 10.68 vs. 68.10 ± 11.50, respectively). The percentage of women patients was similar: 19.8% in the outpatient group and 27.2% in the inpatient group. Within 30 days after discharge, 73 patients (.31%) and 2 (.07%) patients (p = .02) died in the inpatient group and outpatient group, respectively. The death and rehospitalization rate were similar: 3.8 and 3.5 per 1000 person-months for inpatients and outpatients, respectively. No difference was observed after adjusting for patients' case-mix in the regression model (RR = .99; 95% CI [.82-1.19]).
Outpatient stenting for LEAD did not present any additional risk of early postoperative rehospitalization or death compared with inpatient stenting.
利用真实数据比较下肢动脉疾病（LEAD）门诊与住院血管内治疗的安全性。
本回顾性观察性研究使用了法国国家卫生数据信息系统中 2013 年至 2016 年间接受 LEAD 支架置入术的成年患者的真实数据。主要观察终点为 LEAD 血运重建后第 3 天和第 30 天的全因死亡率、全因住院率、计划性住院率和非计划性住院率。采用倾向评分法控制适应证偏倚。采用泊松回归模型比较门诊和住院环境下的转归率。通过改变感兴趣结局的定义进行敏感性分析。
研究期间共进行了 26715 次介入治疗，其中 2819 次（10.6%）为门诊治疗。门诊患者比住院患者稍年轻（64.73±10.68 岁比 68.10±11.50 岁）。女性患者比例相似：门诊组为 19.8%，住院组为 27.2%。出院后 30 天内，住院组有 73 例（0.31%）和 2 例（0.07%）患者死亡（p=0.02），门诊组分别有 73 例和 2 例（p=0.02）。住院患者和门诊患者的再住院和死亡风险相似：每 1000 人-月分别为 3.8 例和 3.5 例。在回归模型中调整患者的病例组合后，差异无统计学意义（RR=0.99；95%CI[0.82-1.19]）。
与住院支架置入术相比，门诊 LEAD 支架置入术并未增加术后早期再住院或死亡的风险。
