Table 3.
Hierarchical Cox Proportional Hazards Model Assessing Patient- and Physician-Level Characteristics Associated with PVI Reinterventions after Femoropopliteal PVI in the Medicare Population, 2019–2021
| Covariate | Unadjusted Hazard Ratio (95% CI) | Adjusted Hazard Ratio (95% CI) |
|---|---|---|
| Patient-Level Characteristics | ||
| Index PVI | ||
| Atherectomy | 1.85 (1.72, 1.99) | 1.33 (1.21, 1.46) |
| Non-Atherectomy | Ref | Ref |
| Age (years) | ||
| ≤64 | 1.05 (0.94, 1.18) | 1.01 (0.90, 1.14) |
| 65–74 | Ref | Ref |
| 75–84 | 1.08 (1.01, 1.16) | 1.06 (0.99, 1.14) |
| ≥85 | 0.99 (0.87, 1.10) | 0.92 (0.82, 1.04) |
| Sex | ||
| Female | 1.00 (0.94, 1.06) | 0.96 (0.91, 1.03) |
| Male | Ref | Ref |
| Race | ||
| White | Ref | Ref |
| Black | 1.33 (1.22, 1.45) | 1.18 (1.03, 1.34) |
| Asian | 1.20 (0.89, 1.62) | 0.91 (0.67, 1.23) |
| Hispanic | 1.65 (1.42, 1.93) | 1.04 (0.87, 1.23) |
| Other | 1.31 (1.10, 1.56) | 1.20 (1.00, 1.44) |
| Comorbidities | ||
| ESRD | 1.13 (1.05, 1.21) | 1.03 (0.95, 1.12) |
| Diabetes | 1.21 (1.14, 1.28) | 1.13 (1.07, 1.21) |
| Hypertension | 1.04 (0.94, 1.14) | 1.01 (0.92, 1.11) |
| Smoking | 0.92 (0.86, 0.98) | 0.96 (0.90, 1.03) |
| Population density of residence | ||
| Urban | 1.16 (1.09, 1.27) | 1.11 (1.01, 1.22) |
| Rural | Ref | Ref |
| Census region of residence | ||
| Midwest | 0.89 (0.82, 0.97) | 0.92 (0.69, 1.23) |
| Northeast | 0.84 (0.76, 0.93) | 0.87 (0.59, 1.28) |
| South | Ref | Ref |
| West | 1.31 (1.21, 1.42) | 1.44 (1.03, 2.01) |
| Other | 1.72 (0.55, 5.34) | 9.50 (2.44, 36.99) |
| Physician-Level Characteristics | ||
| Sex | ||
| Male | 1.79 (1.33, 2.38) | 1.52 (1.12–2.04) |
| Female | Ref | Ref |
| Years since medical school graduation | ||
| ≤10 | 0.92 (0.76, 1.12) | 1.04 (0.83, 1.30) |
| 11–20 | 1.16 (1.07, 1.25) | 1.05 (0.93, 1.20) |
| 21–30 | 1.08 (0.99, 1.17) | 1.02 (0.91, 1.14) |
| ≥31 | Ref | Ref |
| Census region of practice location | ||
| Midwest | 0.90 (0.83, 0.98) | 1.11 (0.83, 1.50) |
| Northeast | 0.85 (0.76, 0.94) | 1.06 (0.73, 1.55) |
| South | Ref | Ref |
| West | 1.28 (1.19, 1.39) | 0.82 (0.58, 1.17) |
| Other | 0.63 (0.09, 4.43) | 0.08 (0.02, 0.32) |
| Population density of practice location | ||
| Urban | Ref | Ref |
| Rural | 0.94 (0.83, 1.06) | 0.97 (0.82, 1.15) |
| Primary specialty | ||
| Vascular surgery | Ref | Ref |
| Cardiology | 1.26 (1.18, 1.35) | 1.22 (1.09, 1.38) |
| General surgery | 0.90 (0.76, 1.06) | 0.99 (0.80, 1.23) |
| Radiology | 1.82 (1.64, 2.02) | 1.55 (1.31, 1.83) |
| Cardiothoracic surgery | 1.44 (1.16, 1.79) | 1.51 (1.08, 2.13) |
| Other | 1.81 (1.51, 2.17) | 1.59 (1.20, 2.11) |
| Number of patients treated with index femoropopliteal PVI | ||
| 11–14 | Ref | Ref |
| 15–22 | 1.17 (1.06, 1.28) | 1.11 (0.99, 1.24) |
| 23–189 | 1.49 (1.37, 1.62) | 1.23 (1.10, 1.37) |
| Overall percentage of services delivered in ASC or OBL | ||
| 0–39% | Ref | Ref |
| 40–70% | 1.12 (1.03, 1.21) | 1.07 (0.96, 1.20) |
| 71–100% | 1.43 (1.32, 1.54) | 1.10 (0.96, 1.24) |
| Physician quartile for index atherectomy use | ||
| Q1 | Ref | Ref |
| Q2 | 1.31 (1.17, 1.47) | 1.06 (0.92, 1.22) |
| Q3 | 1.72 (1.54, 1.91) | 1.22 (1.05, 1.42) |
| Q4 | 2.37 (2.15, 2.61) | 1.49 (1.27, 1.74) |
PVI, peripheral vascular intervention; ESRD, end-stage renal disease; ASC, ambulatory surgical center; OBL, office-based laboratory