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Low operator PCI volume linked to worse outcomes, higher cost
LAS VEGAS — The fewer PCI procedures an operator performs in a given year, the higher the rate of mortality and periprocedural complications for his or her patients, according to data presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.
Low operator and institutional PCI volumes are also associated with longer lengths of stay and higher costs, the researchers found.
Nileshkumar J. Patel, MD, from Staten Island University Hospital in New York, presented findings on mortality and complications, and Vikas Singh, MD, from the University of Miami Miller School of Medicine, presented data on length of stay and cost.
Nileshkumar J. Patel
The researchers used the Nationwide Inpatient Sample (NIS) databases from 2005 to 2009 to analyze 457,498 cases of PCI resulting in stent placement. The mean age of the patients was 64 years, 66.2% were men and 69.7% were white. The cases were stratified into quartiles based on current annual operator PCI volume and by current annual institutional PCI volume. Because the NIS gives operators a different identifying number in different years, lifetime volume or multi-year volume could not be analyzed, Singh said.
The primary outcome was in-hospital mortality. The secondary outcome was a composite of in-hospital mortality and periprocedural complications; other outcomes were length of stay and cost. The researchers also analyzed outcomes for two high-risk subgroups: patients with MI and patients who had a shock or assist device used.
Vikas Singh
Overall, in-hospital mortality occurred in 1.2% of patients and the secondary outcome of in-hospital mortality plus periprocedural complications occurred in 7.1% of patients, Patel said.
Lower volume, worse outcomes
The lower the operator volume in that year, the more likely his or her patient’s chance of in-hospital mortality (quartile 1, 1.68%; quartile 2, 1.15%; quartile 3, 0.87%; quartile 4, 0.59%; P<.001) and in-hospital mortality or complication (quartile 1, 10.91%; quartile 2, 7.75%; quartile 3, 6.4%; quartile 4, 5.51%; P<.001). This trend remained after adjustments for confounders, Patel said.
The rate of poor outcomes began to attenuate at a volume of approximately 50 to 75 PCI procedures per year, and flattened after 100 procedures per year, he said.
The same trend was present in patients with MI and patients who had shock or assist devices used (P<.001 for all comparisons), but at higher rates. Patients with MI had a 3.5% rate of in-hospital mortality and a 13.5% rate of in-hospital mortality or complications, and patients who had shock or assist devices had a 27.3% rate of in-hospital mortality and a 60.1% rate of in-hospital mortality or complications, according to Patel.
“Despite recent advancements, the volume-outcome relationship still exists in our study,” Patel said. “We encourage participation in national registries, which can help improve performance and encourage quality improvements.”
Cost, stay also affected
The mean length of stay was 2.81 days and the mean cost of hospitalization was $17,894, Singh said.
The lower the operator volume in that year, the more likely his or her patient’s length of stay was to be long and cost of hospitalization was to be high, and the same was true the lower the institutional volume in that year, Singh said. He noted that the trend remained after adjusting for confounders (P<.001 for all comparisons). – by Erik Swain
For more information:
Patel NJ. Best of the Best Abstracts: Abstract O-008.
Singh V. Best of the Best Abstracts: Abstract O-004. Both presented at: the Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 28-31, 2014; Las Vegas.
Disclosure: Patel and Singh report no relevant financial disclosures.