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Safety and Efficacy of Vascular Interventions Performed in a Busy Office-based Surgery Center (OBSC) in Selected Patients with Low and Moderate Periprocedural Risk
Enrico Ascher, MD, Yuriy Ostrozhynskyy, Anil Hingorani, MD, Sheila Blumberg, MD, Natalie Marks, MD, Matt Goldstein, MD, Pavel Kibrik, MD, Jacob Mandel.
Total Vascular Care, Brooklyn, NY, USA.

OBJECTIVE:
An explosion in number of OBSCs occurred in US since Center for Medicare and Medicaid Services increased reimbursement for outpatient vascular interventions in 2008. Yet, there is paucity of published data to support OBSC patient safety and treatment effectiveness.
METHODS: 
During 4-year period 2779 patients underwent 6200 minimally invasive procedures at State licensed/AAAAF accredited OBSC. Age ranged (21-99), average age (66.513.31years). There were 1852(67%) females and 928(33%) males. Exclusions: weight>350 pounds, American Society of Anesthesiologists Physical Status Classification class 4-5 and potentially complex/long procedures. In group 1 (venous), 5% ASA I, 61% ASA II, 32% ASA III, 2% ASA IV. In group 2 (arterial), 0% ASA I, 74% ASA II, 24% ASA III, 3% ASA IV. Only local anesthesia used. Group I: 5783 venous procedures (3491 vein ablation, 2292 iliac vein stenting); Group-II 238 arterial procedures (125 femoral/popliteal, 71 infrapopliteal, iliac 42); Group III-129 arterial-venous accesses and Group IV-51 inferior vena cava filters. Arterial closures devices used in all arterial interventions.
RESULTS: 
5% patients deemed ASA class 4. (All on hemodialysis). There were no OBSC mortality, major bleed, acute limb ischemia, MI, stroke or hospital transfer within 72 hours. Complications not requiring hospital care occurred in 14 patients(0.5%). One-month mortality occurred in 9 patients(0.32%). No significant differences in outcomes among 4 groups. Effectiveness among various procedures comparable to ones published in literature.
CONCLUSIONS: 
These data suggest it is safe to use OBSC for minimally invasive, non-complex vascular interventions in patients with low-moderate cardiovascular procedural risk.


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