Effect of Hospital Volume on Outcomes of Transcatheter Aortic Valve Implantation.

Autor: Badheka AO; Cardiology Department, Yale School of Medicine, New Haven, Connecticut., Patel NJ; Internal Medicine Department, Staten Island University Hospital, Staten Island, New York., Panaich SS; Cardiology Department, Detroit Medical Center, Detroit, Michigan., Patel SV; Internal Medicine Department, Western Reserve Health System, Youngstown, Ohio., Jhamnani S; Cardiology Department, Yale School of Medicine, New Haven, Connecticut., Singh V; Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida., Pant S; Internal Medicine Department, University of Louisville, Louisville, Kentucky., Patel N; Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida., Patel N; Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New Jersey., Arora S; Internal Medicine Department, Mount Sinai St Luke's Roosevelt, New York, New York., Thakkar B; Internal Medicine Department, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana., Manvar S; Cardiology Department, Detroit Medical Center, Detroit, Michigan., Dhoble A; Internal Medicine Department, UT Houston Health Science Center, Houston, Texas., Patel A; Internal Medicine Department, Icahn School of Medicine at Mount Sinai, New York, New York., Savani C; Internal Medicine Department, New York Medical College, Valhalla, New York., Patel J; Cardiology Department, Detroit Medical Center, Detroit, Michigan., Chothani A; Internal Medicine Department, Med Star Washington Hospital Center, Washington, D.C., Savani GT; Internal Medicine Department, Prince George's Hospital Center, Cheverly, Maryland., Deshmukh A; Cardiology Department, Mayo Clinic, Rochester, Minnesota., Grines CL; Cardiology Department, Detroit Medical Center, Detroit, Michigan., Curtis J; Cardiology Department, Yale School of Medicine, New Haven, Connecticut., Mangi AA; Cardiology Department, Yale School of Medicine, New Haven, Connecticut., Cleman M; Cardiology Department, Yale School of Medicine, New Haven, Connecticut., Forrest JK; Cardiology Department, Yale School of Medicine, New Haven, Connecticut. Electronic address: john.k.forrest@yale.edu.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2015 Aug 15; Vol. 116 (4), pp. 587-94. Date of Electronic Publication: 2015 May 21.
DOI: 10.1016/j.amjcard.2015.05.019
Abstrakt: Transcatheter aortic valve implantation (TAVI) is associated with a significant learning curve. There is paucity of data regarding the effect of hospital volume on outcomes after TAVI. This is a cross-sectional study based on Healthcare Cost and Utilization Project's Nationwide Inpatient Sample database of 2012. Subjects were identified by International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes, 35.05 (Trans-femoral/Trans-aortic Replacement of Aortic Valve) and 35.06 (Trans-apical Replacement of Aortic Valve). Annual hospital TAVI volumes were calculated using unique identification numbers and then divided into quartiles. Multivariate logistic regression models were created. The primary outcome was inhospital mortality; secondary outcome was a composite of inhospital mortality and periprocedural complications. Length of stay (LOS) and cost of hospitalization were assessed. The study included 1,481 TAVIs (weighted n = 7,405). Overall inhospital mortality rate was 5.1%, postprocedural complication rate was 43.4%, median LOS was 6 days, and median cost of hospitalization was $51,975. Inhospital mortality rates decreased with increasing hospital TAVI volume with a rate of 6.4% for lowest volume hospitals (first quartile), 5.9% (second quartile), 5.2% (third quartile), and 2.8% for the highest volume TAVI hospitals (fourth quartile). Complication rates were significantly higher in hospitals with the lowest volume quartile (48.5%) compared to hospitals in the second (44.2%), third (39.7%), and fourth (41.5%) quartiles (p <0.001). Increasing hospital volume was independently predictive of shorter LOS and lower hospitalization costs. In conclusion, higher annual hospital volumes are significantly predictive of reduced postprocedural mortality, complications, shorter LOS, and lower hospitalization costs after TAVI.
(Copyright © 2015 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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