Satiani, Bhagwan

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Invited commentary 

JOURNAL OF VASCULAR SURGERY
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in patients with intermittent claudicaion. J Vasc Surg 2006;44:115-8.Submitted Feb 20, 2009; accepted Jun 8, 2009.INVITED COMMENTARYBhagwan Satiani, MD, MBA, Columbus, Ohio
The authors examine market share trends and outcomes for
vascular surgeons (VS), interventional radiologists (IR), and inter-
ventional cardiologists (IC) performing peripheral arterial inter-
ventions (PAI) during 1998-2005, utilizing retrospective data
from the National Inpatient Sample. Their conclusions that VS
(and IC) volumes have increased significantly along with the
lowest mortality and morbidity using iatrogenic injuries as a
marker will warm the hearts of current and future VS. However, it
must be remembered that the 23,825 cases represent a very small
sample of inpatients and approximately 3% of all interventions
performed annually in the U.S. In addition, almost 25% of inter-
ventionist specialties could not be discerned, intra-arterial injury
was used as the sole marker for morbidity, and interventionist
specialties were deduced indirectly through an algorithm based on
the type of procedures performed.
Nevertheless, the tantalizing and encouraging conclusions
should cause us to study trends in overall market share for periph-
eral interventions and focus on the common quality measures most
departments and hospitals utilize to issue ‘report’ cards. The
American Recovery and Reinvestment Act of 2009 (ARRA) calls
for a vague mandate for ‘comparative effectiveness research.’ Whatthough the Pay for Performance (P4P) program initiated byMedi-
care and followed by private insurers has not caught on as much as
was expected due to the dwarfian incentives, the Physician Quality
Reporting Initiative (PQRI) measures will probably be expanded.
The authors also noted that IC had the highest rates of elective
admissions for peripheral interventions, suggesting, as others have,
that some IC ‘find’ these lesions during cardiac catheterizations.
VS are heavily outnumbered by sheer numbers of IC and yet I
suspect that the increased market share for VS has resulted from an
aggressive approach by our specialty in teaching its members and
trainees the skill sets needed to achieve superior results.
Total transparency of results and quality indicators made
public in a proactive manner is critical to prevent insurance or
governmental efforts to impose their own ill-defined standards.
The specialty that acts in a coordinated and proactive manner to
demonstrate the quality of work (tied to low mortality and com-
plication rates and hence lower costs) performed by its members
will eventually be the dominant specialty. A combination of first-
rate training of the complete specialist (open/closed procedures),
demonstration of superior results by hard data, and occasionally
tooting our own horn should stand the future generation of VS in
good stead.


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