Apurva O Badheka1, Nileshkumar J Patel2, Peeyush Grover2, Vikas Singh2, Nilay Patel2, Shilpkumar Arora2, Ankit Chothani2, Kathan Mehta2, Abhishek Deshmukh2, Ghanshyambhai T Savani2, Achint Patel2, Sidakpal S Panaich2, Neeraj Shah2, Ankit Rathod2, Michael Brown2, Tamam Mohamad2, Frank V Tamburrino2, Saibal Kar2, Raj Makkar2, William W O'Neill2, Eduardo De Marchena2, Theodore Schreiber2, Cindy L Grines2, Charanjit S Rihal2, Mauricio G Cohen2. 1. From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.). apurva.badheka@yale.edu. 2. From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.).
Abstract
BACKGROUND: The relationship between operator or institutional volume and outcomes among patients undergoing percutaneous coronary interventions (PCI) is unclear. METHODS AND RESULTS: Cross-sectional study based on the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample between 2005 to 2009. Subjects were identified by International Classification of Diseases, 9(th) Revision, Clinical Modification procedure code, 36.06 and 36.07. Annual operator and institutional volumes were calculated using unique identification numbers and then divided into quartiles. Three-level hierarchical multivariate mixed models were created. The primary outcome was in-hospital mortality; secondary outcome was a composite of in-hospital mortality and peri-procedural complications. A total of 457,498 PCIs were identified representing a total of 2,243,209 PCIs performed in the United States during the study period. In-hospital, all-cause mortality was 1.08%, and the overall complication rate was 7.10%. The primary and secondary outcomes of procedures performed by operators in 4(th) [annual procedural volume; primary and secondary outcomes] [>100; 0.59% and 5.51%], 3(rd) [45-100; 0.87% and 6.40%], and 2(nd) quartile [16-44; 1.15% and 7.75%] were significantly less (P<0.001) when compared with those by operators in the 1(st) quartile [≤15; 1.68% and 10.91%]. Spline analysis also showed significant operator and institutional volume outcome relationship. Similarly operators in the higher quartiles witnessed a significant reduction in length of hospital stay and cost of hospitalization (P<0.001). CONCLUSIONS: Overall in-hospital mortality after PCI was low. An increase in operator and institutional volume of PCI was found to be associated with a decrease in adverse outcomes, length of hospital stay, and cost of hospitalization.
BACKGROUND: The relationship between operator or institutional volume and outcomes among patients undergoing percutaneous coronary interventions (PCI) is unclear. METHODS AND RESULTS: Cross-sectional study based on the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample between 2005 to 2009. Subjects were identified by International Classification of Diseases, 9(th) Revision, Clinical Modification procedure code, 36.06 and 36.07. Annual operator and institutional volumes were calculated using unique identification numbers and then divided into quartiles. Three-level hierarchical multivariate mixed models were created. The primary outcome was in-hospital mortality; secondary outcome was a composite of in-hospital mortality and peri-procedural complications. A total of 457,498 PCIs were identified representing a total of 2,243,209 PCIs performed in the United States during the study period. In-hospital, all-cause mortality was 1.08%, and the overall complication rate was 7.10%. The primary and secondary outcomes of procedures performed by operators in 4(th) [annual procedural volume; primary and secondary outcomes] [>100; 0.59% and 5.51%], 3(rd) [45-100; 0.87% and 6.40%], and 2(nd) quartile [16-44; 1.15% and 7.75%] were significantly less (P<0.001) when compared with those by operators in the 1(st) quartile [≤15; 1.68% and 10.91%]. Spline analysis also showed significant operator and institutional volume outcome relationship. Similarly operators in the higher quartiles witnessed a significant reduction in length of hospital stay and cost of hospitalization (P<0.001). CONCLUSIONS: Overall in-hospital mortality after PCI was low. An increase in operator and institutional volume of PCI was found to be associated with a decrease in adverse outcomes, length of hospital stay, and cost of hospitalization.
Authors: Kipp Slicker; Wesley G Lane; Ola O Oyetayo; Laurel A Copeland; Eileen M Stock; Jeffrey B Michel; John P Erwin Journal: Cardiovasc Diagn Ther Date: 2016-10
Authors: Alexander C Fanaroff; Pearl Zakroysky; Daniel Wojdyla; Lisa A Kaltenbach; Matthew W Sherwood; Matthew T Roe; Tracy Y Wang; Eric D Peterson; Hitinder S Gurm; Mauricio G Cohen; John C Messenger; Sunil V Rao Journal: Circulation Date: 2019-01-22 Impact factor: 29.690
Authors: D C Eindhoven; E Wierda; M C de Bruijne; G Amoroso; B A J M de Mol; V A W M Umans; M J Schalij; C J W Borleffs Journal: Neth Heart J Date: 2015-09 Impact factor: 2.380