We read the report published by Arora et al regarding the impact of hospital volumes on outcomes after lower extremity endovascular interventions. Although the results of the report come as no surprise to an experienced endovascular interventionalist, one would certainly express reservations about using an inpatient database for assessment of hospital volumes in lower extremity endovascular interventions. Lower extremity interventions may not be treated in the same light as other higher risk interventions such as transcatheter aortic valve replacement, which always requires inpatient admissions. Data from the Healthcare Cost and Utilization Project using State Ambulatory Surgical Database published in 2014 by Lo et al estimated that 65% of all endovascular procedures in men and 61% of all endovascular procedures in women, in 2009, were performed in the outpatient ambulatory setting. Although one would believe that major complications such as bleeding or need for amputation would require inpatient hospitalization, exclusion of a large number of low-risk procedures (that were discharged on the same day) from the denominator would lead to a marked overestimation of these estimates. In addition, one could surmise that the number of ambulatory procedures performed (vs inpatient procedures) in an institution would likely depend on the risk profile catered to by that institution, which in turn is dependent on the institutional volume. This would imply a differential impact of procedural risk on outpatient procedural volume in different institutions, which cannot be systematically evaluated without actually obtaining the real outpatient data. We agree that Nationwide Inpatient Sample is a rich resource of information, which has been used by several groups to answer important questions, this question in particular is only partly answered by use of this data set in isolation. Perhaps utilization of more robust databases, which provide insight into real-world outpatient surgical procedures, would provide more truthful and more complete insight into this important question.