scholarly journals Survival and Causes of Death Among Veterans With Lower Extremity Revascularization With Paclitaxel‐Coated Devices: Insights From the Veterans Health Administration

2021 ◽  
Vol 10 (4) ◽  
Author(s):  
Jorge Antonio Gutierrez ◽  
Sunil V. Rao ◽  
William Schuyler Jones ◽  
Eric A. Secemsky ◽  
Aaron W. Aday ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Veterans Health Administration ◽  
Endovascular Intervention ◽  
Veterans Administration ◽  
Veterans Health ◽  
Coding System ◽  
Health Administration ◽  
Term Survival ◽  
All Cause Mortality

BACKGROUND The long‐term safety of paclitaxel‐coated devices (PCDs; drug‐coated balloon or drug‐eluting stent) for peripheral endovascular intervention is uncertain. We used data from the Veterans Health Administration to evaluate the association between PCDs, long‐term mortality, and cause of death. METHODS AND RESULTS Using the Veterans Administration Corporate Data Warehouse in conjunction with International Classification of Diseases, Tenth Revision ( ICD‐10 ) Procedure Coding System, Current Procedural Terminology, and Healthcare Common Procedure Coding System codes, we identified patients with peripheral artery disease treated within the Veterans Administration for femoropopliteal artery revascularization between October 1, 2015, and June 30, 2019. An adjusted Cox regression, using stabilized inverse probability–weighted estimates, was used to evaluate the association between PCDs and long‐term survival. Cause of death data were obtained using the National Death Index. In total, 10 505 patients underwent femoropopliteal peripheral endovascular intervention; 2265 (21.6%) with a PCD and 8240 (78.4%) with a non‐PCD (percutaneous angioplasty balloon and/or bare metal stent). Survival rates at 2 years (77.4% versus 79.7%) and 3 years (70.7% versus 71.8%) were similar between PCD and non‐PCD groups, respectively. The adjusted hazard for all‐cause mortality for patients treated with a PCD versus non‐PCD was 1.06 (95% CI, 0.95–1.18, P =0.3013). Among patients who died between October 1, 2015, and December 31, 2017, the cause of death according to treatment group, PCD versus non‐PCD, was similar. CONCLUSIONS Among patients undergoing femoropopliteal peripheral endovascular intervention within the Veterans Administration Health Administration, there was no increased risk of long‐term, all‐cause mortality associated with PCD use. Cause‐specific mortality rates were similar between treatment groups.

scholarly journals Regional and Rural–Urban Variation in Opioid Prescribing in the Veterans Health Administration

2019 ◽  
Vol 184 (11-12) ◽  
pp. 894-900 ◽  
Author(s):  
Brian C Lund ◽  
Michael E Ohl ◽  
Katherine Hadlandsmyth ◽  
Hilary J Mosher
Keyword(s):  
Rural Areas ◽  
Regional Variation ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use ◽  
Opioid Prescribing ◽  
Rural And Urban ◽  
Per Capita

Abstract Introduction Opioid prescribing is heterogenous across the US, where 3- to 5-fold variation has been observed across states or other geographical units. Residents of rural areas appear to be at greater risk for opioid misuse, mortality, and high-risk prescribing. The Veterans Health Administration (VHA) provides a unique setting for examining regional and rural–urban differences in opioid prescribing, as a complement and contrast to extant literature. The objective of this study was to characterize regional variation in opioid prescribing across Veterans Health Administration (VHA) and examine differences between rural and urban veterans. Materials and Methods Following IRB approval, this retrospective observational study used national administrative VHA data from 2016 to assess regional variation and rural–urban differences in schedule II opioid prescribing. The primary measure of opioid prescribing volume was morphine milligram equivalents (MME) dispensed per capita. Secondary measures included incidence, prevalence of any use, and prevalence of long-term use. Results Among 4,928,195 patients, national VHA per capita opioid utilization in 2016 was 1,038 MME. Utilization was lowest in the Northeast (894 MME), highest in the West (1,368 MME), and higher among rural (1,306 MME) than urban (988 MME) residents (p < 0.001). Most of the difference between rural and urban veterans (318 MME) was attributable to differences in long-term opioid use (312 MME), with similar rates of short-term use. Conclusion There is substantial regional and rural–urban variation in opioid prescribing in VHA. Rural veterans receive over 30% more opioids than their urban counterparts. Further research is needed to identify and address underlying causes of these differences, which could include access barriers for non-pharmacologic treatments for chronic pain.

scholarly journals Health Outcomes Among Long-term Opioid Users With Testosterone Prescription in the Veterans Health Administration

2019 ◽  
Vol 2 (12) ◽  
pp. e1917141 ◽  
Author(s):  
Guneet K. Jasuja ◽  
Omid Ameli ◽  
Joel I. Reisman ◽  
Adam J. Rose ◽  
Donald R. Miller ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Users

scholarly journals Emergency Physician Opioid Prescribing and Risk of Long-term Use in the Veterans Health Administration: an Observational Analysis

2019 ◽  
Vol 34 (8) ◽  
pp. 1522-1529 ◽  
Author(s):  
Michael L. Barnett ◽  
Xinhua Zhao ◽  
Michael J. Fine ◽  
Carolyn T. Thorpe ◽  
Florentina E. Sileanu ◽  
...  
Keyword(s):  
Emergency Physician ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Observational Analysis ◽  
Opioid Prescribing

Colorectal liver metastases management in the Veterans Health Administration: Geographic disparity.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 694-694
Author(s):  
Dalia A. Mobarek ◽  
Brendan C. Visser ◽  
Steven Krasnow ◽  
Ji Won Chang ◽  
Patricia Nechodom ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Performance Status ◽  
Stage Iv ◽  
Veterans Health Administration ◽  
Disease Diagnosis ◽  
Veterans Health ◽  
Health Administration ◽  
Term Survival ◽  
Geographic Disparity

694 Background: Multidisciplinary management including surgical resection of Colorectal Liver Metastases (CLM) offers the greatest chance of long-term survival. We aimed to study surgical intervention types, rates and factors affecting the decision making in the Veterans Health Administration. Methods: The Veterans Affairs Central Cancer Registry (VACCR) and VA Informatics & Computing Infrastructure (VINCI) were queried and linked to retrospectively analyze stage IV CLM from 10/01/2004-12/31/2012. Cohort construction and statistical analyses were performed utilizing SQL Server, SAS software, version 9.4 (SAS Institute Inc., Cary, NC) and Microsoft Excel. Results: We identified 118 VA stations and 1245 subjects meeting the inclusion criteria. Hemicolectomy was identified in 79%, (637) and 21 % (168) liver metastatectomy. Open versus laparoscopic hemicolectomy was 87.96% and 12.04% respectively. Follow-up imaging post metastatic disease diagnosis was carried in 88.9% (1,108) subjects. Immense variation in the percentage of surgeries conducted and the sites of surgery when stratified by geographic location. The percentage of patients receiving surgery at the colon remained high across almost all the stations. In 53 stations, hemicolectomy and hepatectomy were attempted in at least 15% of subjects with stage IV colorectal cancer and isolated liver metastases. Of the high volume stations, only 52% had a 15% or higher percentage of hemicolectomy and hepatectomy. Subjects receiving hepatectomy only were the least frequent and occurred in only three stations. Age at diagnosis, gender, Charlson comorbidity scores and the performance status at diagnosis did not differ significantly among surgery versus no-surgery groups. Conclusions: Geographic disparity emerged as a factor affecting metastatectomy decisions. Ongoing analysis to identify and analyze the differences amongst various stations is underway. Additional characterization of the liver metastases including size, number, and specific hepatic lobe and the surgical expertise is underway.

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