Christopher P Kovach1, Colin I O'Donnell2, Stanley Swat1, Jacob A Doll3, Mary E Plomondon2, Richard Schofield4, Javier A Valle5, Stephen W Waldo6. 1. Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO, United States of America. 2. Department of Medicine, Rocky Mountain VA Medical Center, Aurora, CO, United States of America; CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC, United States of America. 3. Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, United States of America; Department of Medicine, Puget Sound VA Medical Center, Seattle, WA, United States of America. 4. University of Florida College of Medicine, Gainesville, FL, United States of America; Department of Veterans Affairs Medical Center, Gainesville, FL, United States of America. 5. Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO, United States of America; Michigan Heart and Vascular Institute, Ann Arbor, MI, United States of America. 6. Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO, United States of America; Department of Medicine, Rocky Mountain VA Medical Center, Aurora, CO, United States of America; CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC, United States of America. Electronic address: stephen.waldo@va.gov.
Abstract
BACKGROUND: Recent analyses of the volume-outcome relationship for percutaneous coronary intervention (PCI) have suggested a less robust association than previously reported. It is unknown if novel factors such as lifetime operator experience influence this relationship. OBJECTIVES: To assess the relationship between annual volumes and outcomes for PCI and determine whether lifetime operator experience modulates the association. METHODS: Annual PCI volumes for facilities and operators within the Veterans Affairs Healthcare System and their relationship with 30-day mortality following PCI were described. The influence of operator lifetime experience on the volume-outcome relationship was assessed. Hierarchical logistic regression was used to adjust for patient and procedural factors. RESULTS: 57,608 PCIs performed from 2013 to 2018 by 382 operators and 63 institutions were analyzed. Operator annualized PCI volume averaged 47.6 (standard deviation [SD] 49.1) and site annualized volume averaged 189.2 (SD 105.2). Median operator experience was 9.0 years (interquartile range [IQR] 4.0-15.0). There was no independent relationship between operator annual volume, institutional volume, or operator lifetime experience with 30-day mortality (p > 0.10). However, the interaction between operator volume and lifetime experience was associated with a marginal decrease in mortality (odds ratio [OR] 0.9998, 95% CI 0.9996-0.9999). CONCLUSIONS: There were no significant associations between facility or operator-level procedural volume and 30-day mortality following PCI in a nationally integrated healthcare system. There was a marginal association between the interaction of operator lifetime experience, operator annual volume, and 30-day mortality that is unlikely to be clinically relevant, though does suggest an opportunity to explore novel factors that may influence the volume-outcome relationship. Published by Elsevier Inc.
BACKGROUND: Recent analyses of the volume-outcome relationship for percutaneous coronary intervention (PCI) have suggested a less robust association than previously reported. It is unknown if novel factors such as lifetime operator experience influence this relationship. OBJECTIVES: To assess the relationship between annual volumes and outcomes for PCI and determine whether lifetime operator experience modulates the association. METHODS: Annual PCI volumes for facilities and operators within the Veterans Affairs Healthcare System and their relationship with 30-day mortality following PCI were described. The influence of operator lifetime experience on the volume-outcome relationship was assessed. Hierarchical logistic regression was used to adjust for patient and procedural factors. RESULTS: 57,608 PCIs performed from 2013 to 2018 by 382 operators and 63 institutions were analyzed. Operator annualized PCI volume averaged 47.6 (standard deviation [SD] 49.1) and site annualized volume averaged 189.2 (SD 105.2). Median operator experience was 9.0 years (interquartile range [IQR] 4.0-15.0). There was no independent relationship between operator annual volume, institutional volume, or operator lifetime experience with 30-day mortality (p > 0.10). However, the interaction between operator volume and lifetime experience was associated with a marginal decrease in mortality (odds ratio [OR] 0.9998, 95% CI 0.9996-0.9999). CONCLUSIONS: There were no significant associations between facility or operator-level procedural volume and 30-day mortality following PCI in a nationally integrated healthcare system. There was a marginal association between the interaction of operator lifetime experience, operator annual volume, and 30-day mortality that is unlikely to be clinically relevant, though does suggest an opportunity to explore novel factors that may influence the volume-outcome relationship. Published by Elsevier Inc.
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