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Xu J, Xu X, Tian J, Huang M, Xia Z, Luo X, Zheng J, Huang K. Comparison of day surgery between varicose veins with and without superficial venous thrombosis below knee: a propensity score-matched analysis. BMC Cardiovasc Disord 2023; 23:387. [PMID: 37537563 PMCID: PMC10401813 DOI: 10.1186/s12872-023-03398-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVES Development of endovenous treatment and sclerotherapy technology makes it feasible for clinicians to treat varicose veins (VV) through day surgery (DS). Superficial venous thrombosis (SVT) of lower extremities is a common complication of VV. This study aimed to investigate whether the existence of SVT below knee affect the safety and efficacy of DS for VV patients. METHODS This is a single-center retrospective study. Clinical data of 593 VV patients was retrospectively analyzed. Raw data were matched by the using of propensity score matching model. Operation time, technical failure, postoperative DVT, skin burns, saphenous nerve injury, subcutaneous induration, and bleeding were compared between the groups. Also, we compared VV recurrence, SVT formation, DVT events and the change of VCSS score with 12 months. RESULTS Fifty-nine patients complicated with SVT below knee were matched with 118 patients had VV only. Perioperative and follow-up outcomes were similar in both groups except for the number of incisions (median = 6 [5, 7] VS median = 4 [4, 5], P < 0.001). Both groups experienced a great decrease in VCSS score. CONCLUSION We systematically compared the clinical outcomes of DS in VV patients. Our results indicate DS is safe and effective for patients with VV, whether accompanied by SVT below the knee. TRIAL REGISTRATION The ClinicalTrials.gov identifier for this trial is NCT05380895 (retrospectively registered).
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Affiliation(s)
- Jiatang Xu
- Department of Cardiovascular Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Haizhu District, No.33, Yingfeng Road, Guangzhou, 510000, Guangdong Province, China
- Zhongshan School of Medicine, Sun Yat-Sen University, No.58, Zhongshan Rd.2, Guangzhou, 510080, Guangdong Province, China
| | - Xiaolin Xu
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Haizhu District, No.33, Yingfeng Road, Guangzhou, 510000, Guangdong Province, China
| | - Jing Tian
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Haizhu District, No.33, Yingfeng Road, Guangzhou, 510000, Guangdong Province, China
| | - Minyi Huang
- Operating Theatre, Sun Yat-Sen University, No.58, Zhongshan Rd.2, Guangzhou, 510080, Guangdong Province, China
| | - Zuqi Xia
- Zhongshan School of Medicine, Sun Yat-Sen University, No.58, Zhongshan Rd.2, Guangzhou, 510080, Guangdong Province, China
| | - Xianghui Luo
- Operating Theatre, Sun Yat-Sen University, No.58, Zhongshan Rd.2, Guangzhou, 510080, Guangdong Province, China
| | - Junmeng Zheng
- Department of Cardiovascular Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Haizhu District, No.33, Yingfeng Road, Guangzhou, 510000, Guangdong Province, China.
- Zhongshan School of Medicine, Sun Yat-Sen University, No.58, Zhongshan Rd.2, Guangzhou, 510080, Guangdong Province, China.
| | - Kai Huang
- Department of Cardiovascular Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Haizhu District, No.33, Yingfeng Road, Guangzhou, 510000, Guangdong Province, China.
- Zhongshan School of Medicine, Sun Yat-Sen University, No.58, Zhongshan Rd.2, Guangzhou, 510080, Guangdong Province, China.
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Lopez CD, Boddapati V, Schweppe EA, Levine WN, Lehman RA, Lenke LG. Recent Trends in Medicare Utilization and Reimbursement for Orthopaedic Procedures Performed at Ambulatory Surgery Centers. J Bone Joint Surg Am 2021; 103:1383-1391. [PMID: 33780398 DOI: 10.2106/jbjs.20.01105] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND As part of a market-driven response to the increasing costs of hospital-based surgical care, an increasing volume of orthopaedic procedures are being performed in ambulatory surgery centers (ASCs). The purpose of the present study was to identify recent trends in orthopaedic ASC procedure volume, utilization, and reimbursements in the Medicare system between 2012 and 2017. METHODS This cross-sectional, national study tracked annual Medicare claims and payments and aggregated data at the county level. Descriptive statistics and multivariate regression models were used to evaluate trends in procedure volume, utilization rates, and reimbursement rates, and to identify demographic predictors of ASC utilization. RESULTS A total of 1,914,905 orthopaedic procedures were performed at ASCs in the Medicare population between 2012 and 2017, with an 8.8% increase in annual procedure volume and a 10.5% increase in average reimbursements per case. ASC orthopaedic procedure utilization, including utilization across all subspecialties, is strongly associated with metropolitan areas compared with rural areas. In addition, orthopaedic procedure utilization, including for sports and hand procedures, was found to be significantly higher in wealthier counties (measured by average household income) and in counties located in the South. CONCLUSIONS This study demonstrated increasing orthopaedic ASC procedure volume in recent years, driven by increases in hand procedure volume. Medicare reimbursements per case have steadily risen and outpaced the rate of inflation over the study period. However, as orthopaedic practice overhead continues to increase, other Medicare expenditures such as hospital payments and operational and implant costs also must be evaluated. These findings may provide a source of information that can be used by orthopaedic surgeons, policy makers, investors, and other stakeholders to make informed decisions regarding the costs and benefits of the use of ASCs for orthopaedic procedures.
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Affiliation(s)
- Cesar D Lopez
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
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