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Higher hospital volume of endovascular interventions tied to better outcomes
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Hospitals that performed a higher number of endovascular interventions reported better outcomes and lower hospitalization costs than facilities performing fewer procedures, according to recent findings.
The researchers evaluated postprocedural outcomes and hospitalization costs associated with peripheral endovascular interventions, with a focus on outcomes as a function of hospital volume.
The patient population was culled from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2006 to 2011. In-hospital mortality served as the primary outcome measure, with a composite of in-hospital mortality and complications after the procedure comprising a secondary outcome. The researchers also evaluated amputation rates and hospitalization costs as tertiary outcomes.
Hospitals were subdivided into quartiles with regard to procedural volume as follows: fewer than 36 endovascular interventions per year, 37 to 68 procedures, 69 to 126 procedures and more than 126 endovascular interventions per year.
Periprocedural complications occurred in 14.46% of patients overall. Complications occurred in 13.36% of patients treated in the highest volume hospitals vs. 15.66% of those in the lowest volume hospitals (P < .001). The composite of in-hospital mortality and complications also was lower among the highest volume centers (13.61% vs. 16.31% in lowest volume centers; P < .001).
Age was significantly predictive of the primary endpoint (OR = 1.46; 95% CI, 1.37-1.55), according to results from multivariable analysis. Other factors significantly associated with in-hospital mortality included female gender (OR = 1.28; 95% CI, 1.12-1.46), baseline Charlson comorbidity index score of 2 or higher (OR = 4.32; 95% CI, 3.45-5.4), emergent or urgent admission (OR = 2.48; 95% CI, 2.14-2.88) and weekend admission (OR = 1.53; 95% CI, 1.26-1.86).
Greater hospital volume was associated with improvement in both the primary (OR = 0.65; 95% CI, 0.52-0.82 for the highest quartile vs. the lowest) and secondary outcomes (OR = 0.85; 95% CI, 0.73-0.97). A greater procedural volume also was associated with significantly lower amputation rates (OR = 0.52; 95% CI, 0.45-0.61).
Hospitalization costs per patient were $20,673 and were lower in the highest volume hospitals ($18,123 vs. $23,495 in the lowest volume hospitals) Multivariate analysis indicated that greater procedural volume was a predictor of reduced costs (–$3,889; P < .001 for the highest vs. lowest quartile).
“A higher hospital volume is associated with superior postprocedural complication rate and in-hospital mortality after peripheral endovascular interventions,” the researchers concluded. “This, coupled with lower hospitalization costs in higher volume hospitals, indicates a need for further research in this field and possible revision of competency guidelines to include a minimum required hospital procedural volume.”
Disclosure: The researchers report no relevant financial disclosures.
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