TY - JOUR
T1 - Impact of annual operator and institutional volume on percutaneous coronary intervention outcomes
T2 - A 5-year United States experience (2005-2009)
AU - Badheka, Apurva O.
AU - Patel, Nileshkumar J.
AU - Grover, Peeyush
AU - Singh, Vikas
AU - Patel, Nilay
AU - Arora, Shilpkumar
AU - Chothani, Ankit
AU - Mehta, Kathan
AU - Deshmukh, Abhishek
AU - Savani, Ghanshyambhai T.
AU - Patel, Achint
AU - Panaich, Sidakpal S.
AU - Shah, Neeraj
AU - Rathod, Ankit
AU - Brown, Michael
AU - Mohamad, Tamam
AU - Tamburrino, Frank V.
AU - Kar, Saibal
AU - Makkar, Raj
AU - O'Neill, William W.
AU - De Marchena, Eduardo
AU - Schreiber, Theodore
AU - Grines, Cindy L.
AU - Rihal, Charanjit S.
AU - Cohen, Mauricio G.
N1 - Publisher Copyright:
© 2014 American Heart Association, Inc.
PY - 2014
Y1 - 2014
N2 - 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, 9th 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 4th [annual procedural volume; primary and secondary outcomes] [>100; 0.59% and 5.51%], 3rd [45-100; 0.87% and 6.40%], and 2nd quartile [16-44; 1.15% and 7.75%] were significantly less (P<0.001) when compared with those by operators in the 1st 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.
AB - 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, 9th 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 4th [annual procedural volume; primary and secondary outcomes] [>100; 0.59% and 5.51%], 3rd [45-100; 0.87% and 6.40%], and 2nd quartile [16-44; 1.15% and 7.75%] were significantly less (P<0.001) when compared with those by operators in the 1st 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.
KW - Complications
KW - In-hospital mortality
KW - Length of stay
KW - Percutaneous coronary intervention
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U2 - 10.1161/CIRCULATIONAHA.114.009281
DO - 10.1161/CIRCULATIONAHA.114.009281
M3 - Review article
C2 - 25189214
AN - SCOPUS:84925231346
SN - 0009-7322
VL - 130
SP - 1392
EP - 1406
JO - Circulation
JF - Circulation
IS - 16
ER -