Impact of Annual Operator and Institutional Volume on Percutaneous Coronary Intervention Outcomes A 5-Year United States Experience (2005-2009)

被引：146

作者：

Badheka, Apurva O. ^{[1
]}

Patel, Nileshkumar J. ^{[2
]}

Grover, Peeyush ^{[3
]}

Singh, Vikas ^{[4
]}

Patel, Nilay ^{[5
]}

Arora, Shilpkumar ^{[6
]}

Chothani, Ankit ^{[7
]}

Mehta, Kathan ^{[8
]}

Deshmukh, Abhishek ^{[9
]}

Savani, Ghanshyambhai T. ^{[4
]}

Patel, Achint ^{[10
]}

Panaich, Sidakpal S. ^{[11
]}

Shah, Neeraj ^{[2
]}

Rathod, Ankit ^{[12
]}

Brown, Michael ^{[11
]}

Mohamad, Tamam ^{[11
]}

Tamburrino, Frank V. ^{[2
]}

Kar, Saibal ^{[12
]}

Makkar, Raj ^{[12
]}

O'Neill, William W. ^{[13
]}

De Marchena, Eduardo ^{[4
]}

Schreiber, Theodore ^{[11
]}

Grines, Cindy L. ^{[11
]}

Rihal, Charanjit S. ^{[14
]}

Cohen, Mauricio G. ^{[4
]}

机构：

[1] Yale New Haven Med Ctr, New Haven, CT 06520 USA

[2] Staten Isl Univ Hosp, Staten Isl, NY USA

[3] UMass Mem Med Ctr, Worcester, MA USA

[4] Univ Miami, Miller Sch Med, Miami, FL 33136 USA

[5] St Peters Univ Hosp, New Brunswick, NJ USA

[6] Mt Sinais St Luke Roosevelt Hosp Ctr, New York, NY USA

[7] MedStar Washington Hosp Ctr, Washington, DC USA

[8] UPMC Shadyside Hosp, Pittsburgh, PA USA

[9] Univ Arkansas, Little Rock, AR 72204 USA

[10] Icahn Sch Med Mt Sinai, New York, NY 10029 USA

[11] Detroit Med Ctr, Detroit, MI USA

[12] Cedar Sinai Med Ctr, Los Angeles, CA USA

[13] Henry Ford Hosp, Detroit, MI 48202 USA

[14] Mayo Clin, Rochester, MN USA

来源：

CIRCULATION | 2014年 / 130卷 / 16期

关键词：

complications; in-hospital mortality; length of stay; percutaneous coronary intervention; CLINICAL COMPETENCE STATEMENT; ASSOCIATION TASK-FORCE; ATRIAL SEPTAL-DEFECT; HOSPITAL VOLUME; ANGIOPLASTY VOLUME; MORTALITY; REVASCULARIZATION; TRENDS; ERA; COMPLICATIONS;

D O I：

10.1161/CIRCULATIONAHA.114.009281

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：1392 / 1406

页数：15

共 38 条

[1] Specificity of procedure volume and in-hospital mortality association [J].