Claims-based surveillance for reintervention after endovascular aneurysm repair among non-Medicare patients

Jesse A. Columbo*, Art Sedrakyan, Jialin Mao, Andrew Warfield Hoel, Spencer W. Trooboff, Ravinder Kang, Jeremiah R. Brown, Philip P. Goodney

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Objective: Many patients who undergo endovascular aortic aneurysm repair (EVR) also undergo repeat procedures, or reinterventions, to address suboptimal device performance and prevent aneurysm rupture. Quality improvement initiatives measuring reintervention after EVR has focused on fee-for-service Medicare patients. However, because patients aged less than 65 years and those with Medicare Advantage represent an important growing subgroup, we used a novel approach leveraging a state data source that captures patients of all ages and with all types of insurance. Methods: We identified patients who underwent EVR (2011-2015) within the Vascular Quality Initiative registry and were also listed in the Statewide Planning and Research Cooperative System all-payer claims database of New York. We linked patients in the Vascular Quality Initiative to their Statewide Planning and Research Cooperative System claims file at the patient level with a 96% match rate. We compared outcomes between fee-for-service Medicare eligible, defined as age 65 or older or on dialysis, versus ineligible patients, defined as those younger than 65 and not on dialysis. Our primary outcome was reintervention. We used Cox proportional hazards regression and propensity score matching for risk adjustment. Results: We studied 1285 patients with a median follow-up of 16 months (range, 1-57 months). The mean age was 74 years, 79% were male, and 84% of procedures were elective. Nearly one in six patients were not Medicare eligible (14%), and the remainder (86%) were Medicare eligible. Medicare-eligible patients were less likely to be male (77% vs 91%; P <.001), have a history of smoking (79% vs 93%; P <.001), and have a nonelective procedure (15% vs 23%; P =.013). The 3-year Kaplan-Meier rate of reintervention was 21%. We found similar rates of reintervention between Medicare-eligible patients and those who were not (19% vs 20%, log-rank P =.199; unadjusted hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.49-1.16). This finding persisted in both the adjusted and propensity-matched analyses (adjusted HR, 0.82; 95% CI, 0.50-1.34; propensity-matched HR, 0.70; 95% CI, 0.36-1.37). Conclusions: Reintervention can be monitored using administrative claims from both Medicare and non-Medicare payers, and serve as an important outcome metric after EVR in patients of all ages. The rate of reintervention seems to be similar between older, Medicare-eligible individuals, and those who are not yet eligible.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
DOIs
StatePublished - Jan 1 2019

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Aneurysm
Medicare
Fee-for-Service Plans
Confidence Intervals
Blood Vessels
Dialysis
Medicare Part C
Risk Adjustment
Propensity Score
Aortic Aneurysm
Information Storage and Retrieval
Quality Improvement
Insurance
Research
Registries
Rupture
Smoking
Databases
Equipment and Supplies

Keywords

  • All-payer claims
  • Device performance measurement
  • Reintervention after EVR

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Columbo, Jesse A. ; Sedrakyan, Art ; Mao, Jialin ; Hoel, Andrew Warfield ; Trooboff, Spencer W. ; Kang, Ravinder ; Brown, Jeremiah R. ; Goodney, Philip P. / Claims-based surveillance for reintervention after endovascular aneurysm repair among non-Medicare patients. In: Journal of Vascular Surgery. 2019.
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title = "Claims-based surveillance for reintervention after endovascular aneurysm repair among non-Medicare patients",
abstract = "Objective: Many patients who undergo endovascular aortic aneurysm repair (EVR) also undergo repeat procedures, or reinterventions, to address suboptimal device performance and prevent aneurysm rupture. Quality improvement initiatives measuring reintervention after EVR has focused on fee-for-service Medicare patients. However, because patients aged less than 65 years and those with Medicare Advantage represent an important growing subgroup, we used a novel approach leveraging a state data source that captures patients of all ages and with all types of insurance. Methods: We identified patients who underwent EVR (2011-2015) within the Vascular Quality Initiative registry and were also listed in the Statewide Planning and Research Cooperative System all-payer claims database of New York. We linked patients in the Vascular Quality Initiative to their Statewide Planning and Research Cooperative System claims file at the patient level with a 96{\%} match rate. We compared outcomes between fee-for-service Medicare eligible, defined as age 65 or older or on dialysis, versus ineligible patients, defined as those younger than 65 and not on dialysis. Our primary outcome was reintervention. We used Cox proportional hazards regression and propensity score matching for risk adjustment. Results: We studied 1285 patients with a median follow-up of 16 months (range, 1-57 months). The mean age was 74 years, 79{\%} were male, and 84{\%} of procedures were elective. Nearly one in six patients were not Medicare eligible (14{\%}), and the remainder (86{\%}) were Medicare eligible. Medicare-eligible patients were less likely to be male (77{\%} vs 91{\%}; P <.001), have a history of smoking (79{\%} vs 93{\%}; P <.001), and have a nonelective procedure (15{\%} vs 23{\%}; P =.013). The 3-year Kaplan-Meier rate of reintervention was 21{\%}. We found similar rates of reintervention between Medicare-eligible patients and those who were not (19{\%} vs 20{\%}, log-rank P =.199; unadjusted hazard ratio [HR], 0.75; 95{\%} confidence interval [CI], 0.49-1.16). This finding persisted in both the adjusted and propensity-matched analyses (adjusted HR, 0.82; 95{\%} CI, 0.50-1.34; propensity-matched HR, 0.70; 95{\%} CI, 0.36-1.37). Conclusions: Reintervention can be monitored using administrative claims from both Medicare and non-Medicare payers, and serve as an important outcome metric after EVR in patients of all ages. The rate of reintervention seems to be similar between older, Medicare-eligible individuals, and those who are not yet eligible.",
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author = "Columbo, {Jesse A.} and Art Sedrakyan and Jialin Mao and Hoel, {Andrew Warfield} and Trooboff, {Spencer W.} and Ravinder Kang and Brown, {Jeremiah R.} and Goodney, {Philip P.}",
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Claims-based surveillance for reintervention after endovascular aneurysm repair among non-Medicare patients. / Columbo, Jesse A.; Sedrakyan, Art; Mao, Jialin; Hoel, Andrew Warfield; Trooboff, Spencer W.; Kang, Ravinder; Brown, Jeremiah R.; Goodney, Philip P.

In: Journal of Vascular Surgery, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Claims-based surveillance for reintervention after endovascular aneurysm repair among non-Medicare patients

AU - Columbo, Jesse A.

AU - Sedrakyan, Art

AU - Mao, Jialin

AU - Hoel, Andrew Warfield

AU - Trooboff, Spencer W.

AU - Kang, Ravinder

AU - Brown, Jeremiah R.

AU - Goodney, Philip P.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: Many patients who undergo endovascular aortic aneurysm repair (EVR) also undergo repeat procedures, or reinterventions, to address suboptimal device performance and prevent aneurysm rupture. Quality improvement initiatives measuring reintervention after EVR has focused on fee-for-service Medicare patients. However, because patients aged less than 65 years and those with Medicare Advantage represent an important growing subgroup, we used a novel approach leveraging a state data source that captures patients of all ages and with all types of insurance. Methods: We identified patients who underwent EVR (2011-2015) within the Vascular Quality Initiative registry and were also listed in the Statewide Planning and Research Cooperative System all-payer claims database of New York. We linked patients in the Vascular Quality Initiative to their Statewide Planning and Research Cooperative System claims file at the patient level with a 96% match rate. We compared outcomes between fee-for-service Medicare eligible, defined as age 65 or older or on dialysis, versus ineligible patients, defined as those younger than 65 and not on dialysis. Our primary outcome was reintervention. We used Cox proportional hazards regression and propensity score matching for risk adjustment. Results: We studied 1285 patients with a median follow-up of 16 months (range, 1-57 months). The mean age was 74 years, 79% were male, and 84% of procedures were elective. Nearly one in six patients were not Medicare eligible (14%), and the remainder (86%) were Medicare eligible. Medicare-eligible patients were less likely to be male (77% vs 91%; P <.001), have a history of smoking (79% vs 93%; P <.001), and have a nonelective procedure (15% vs 23%; P =.013). The 3-year Kaplan-Meier rate of reintervention was 21%. We found similar rates of reintervention between Medicare-eligible patients and those who were not (19% vs 20%, log-rank P =.199; unadjusted hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.49-1.16). This finding persisted in both the adjusted and propensity-matched analyses (adjusted HR, 0.82; 95% CI, 0.50-1.34; propensity-matched HR, 0.70; 95% CI, 0.36-1.37). Conclusions: Reintervention can be monitored using administrative claims from both Medicare and non-Medicare payers, and serve as an important outcome metric after EVR in patients of all ages. The rate of reintervention seems to be similar between older, Medicare-eligible individuals, and those who are not yet eligible.

AB - Objective: Many patients who undergo endovascular aortic aneurysm repair (EVR) also undergo repeat procedures, or reinterventions, to address suboptimal device performance and prevent aneurysm rupture. Quality improvement initiatives measuring reintervention after EVR has focused on fee-for-service Medicare patients. However, because patients aged less than 65 years and those with Medicare Advantage represent an important growing subgroup, we used a novel approach leveraging a state data source that captures patients of all ages and with all types of insurance. Methods: We identified patients who underwent EVR (2011-2015) within the Vascular Quality Initiative registry and were also listed in the Statewide Planning and Research Cooperative System all-payer claims database of New York. We linked patients in the Vascular Quality Initiative to their Statewide Planning and Research Cooperative System claims file at the patient level with a 96% match rate. We compared outcomes between fee-for-service Medicare eligible, defined as age 65 or older or on dialysis, versus ineligible patients, defined as those younger than 65 and not on dialysis. Our primary outcome was reintervention. We used Cox proportional hazards regression and propensity score matching for risk adjustment. Results: We studied 1285 patients with a median follow-up of 16 months (range, 1-57 months). The mean age was 74 years, 79% were male, and 84% of procedures were elective. Nearly one in six patients were not Medicare eligible (14%), and the remainder (86%) were Medicare eligible. Medicare-eligible patients were less likely to be male (77% vs 91%; P <.001), have a history of smoking (79% vs 93%; P <.001), and have a nonelective procedure (15% vs 23%; P =.013). The 3-year Kaplan-Meier rate of reintervention was 21%. We found similar rates of reintervention between Medicare-eligible patients and those who were not (19% vs 20%, log-rank P =.199; unadjusted hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.49-1.16). This finding persisted in both the adjusted and propensity-matched analyses (adjusted HR, 0.82; 95% CI, 0.50-1.34; propensity-matched HR, 0.70; 95% CI, 0.36-1.37). Conclusions: Reintervention can be monitored using administrative claims from both Medicare and non-Medicare payers, and serve as an important outcome metric after EVR in patients of all ages. The rate of reintervention seems to be similar between older, Medicare-eligible individuals, and those who are not yet eligible.

KW - All-payer claims

KW - Device performance measurement

KW - Reintervention after EVR

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