Title

Impact of annual operator and institutional volume on percutaneous coronary intervention outcomes: a 5-year United States experience (2005-2009).

Document Type

Article

Publication Date

10-14-2014

Publication Title

Circulation

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

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.

Medical Subject Headings

Aged; Coronary Artery Disease; Cross-Sectional Studies; Databases, Factual; Female; Hospital Mortality; Hospitals, High-Volume; Hospitals, Low-Volume; Humans; Length of Stay; Male; Middle Aged; Multivariate Analysis; Percutaneous Coronary Intervention; Risk Assessment; United States

PubMed ID

25189214

Volume

130

Issue

16

First Page

1392

Last Page

1406

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