There is increasing concern that physicians prescribe surgery before exploring evidence-based preoperative methods for treating claudication. A new study by Dr. Ryan Howard, et al, published in the Journal of Vascular Surgery, used data from BMC2 Vascular Surgery peer review to look at the appropriateness of the surgical treatment of claudication.
“Identifying Potentially Avoidable Femoral to Popliteal ePTFE Bypass for Claudication Using Cross Site Blinded Peer Review,” describes BMC2 vascular surgeon review of 325 cross-site cases of elective, open, infrainguinal bypass that were performed for claudication using prosthetic grafts.
Along with their expert opinions, the surgeons were instructed to evaluate appropriateness of the surgical procedure in each case using evidence-based guidelines for preoperative treatment. This included the use of medication, exercise, and smoking cessation as documented in the patient’s medical record.
In 41% of the cases reviewed, surgeons stated that they would not have recommended bypass. 38% of the procedures were deemed inappropriate. Most commonly, the reason for inappropriateness was a lack of preoperative medical and lifestyle therapy.
Approximately $4 million in potentially avoidable costs were associated with procedures deemed inappropriate.
Treating claudication surgically has the potential to lead to both significant costs and surgical complications. Lessons learned from this study results could help align clinical practice to preoperative medical management approaches before turning to surgery, resulting in better outcomes for both patients and payers.
Read more about this study by Ryan Howard, MD, MS; Jeremy Albright, PhD, Rebecca Fleckenstein, MSN, RN; Annemarie Forrest, RN, MS, MPH; Nick Osborne, MD, MS; Matthew A. Corriere, MD, MS; Milan Seth, MS; Eugene Laveroni, Do; John Blebea, MD, MBA; Nicolas Mouawad, MD, MPH, MBA; and Peter Henke, MD on PubMed.