Association of Hospital Procedural Volume With Outcomes of Left Ventricular Assist Device Placement.

Autor: Sagheer S; Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, NM; Division of Interventional Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA. Electronic address: Shazibcheema@gmail.com., Minhas AMK; Division of Medicine, University of Mississippi Medical Center, Jackson, MS, USA., Zaidi SH; Karachi Medical and Dental College, Karachi, Pakistan., Shah I; Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, NM; Division of Interventional Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA., Ahuja KR; Department of Cardiology, Reading Hospital-Tower Health, Reading, PA, USA., Ahuja SK; Department of Internal Medicine, Reading Hospital-Tower Health, Reading, PA, USA., Nazir S; The Aga Khan University, Karachi, Pakistan, and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA., Talha KM; Division of Medicine, University of Mississippi Medical Center, Jackson, MS, USA., Dani SS; Division of Cardiology, Lahey Hospital and Medical Center, Burlington, MA, USA., Fudim M; Division of Cardiology, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA., Abramov D; Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA., Virani SS; The Aga Khan University, Karachi, Pakistan, and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA., Wasty N; Division of Interventional Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA.
Jazyk: angličtina
Zdroj: Journal of cardiac failure [J Card Fail] 2023 Nov; Vol. 29 (11), pp. 1531-1538. Date of Electronic Publication: 2023 Jul 06.
DOI: 10.1016/j.cardfail.2023.06.017
Abstrakt: Background: With the advancement in device technology, the use of durable left ventricular assist devices (LVADs) has increased significantly in recent years. However, there is a dearth of evidence to conclude whether patients who undergo LVAD implantation at high-volume centers have better clinical outcomes than those receiving care at low- or medium-volume centers.
Methods: We analyzed the hospitalizations using the Nationwide Readmission Database for the year 2019 for new LVAD implantation. Baseline comorbidities and hospital characteristics were compared among low- (1-5 procedures/year), medium- (6-16 procedures/year) and high-volume (17-72 procedures/year) hospitals. The volume/outcome relationship was analyzed using the annualized hospital volume as a categorical variable (tertiles) as well as a continuous variable. Multilevel mixed-effect logistic regression and negative binomial regression models were used to determine the association of hospital volume and outcomes, with tertile 1 (low-volume hospitals) as the reference category.
Results: A total of 1533 new LVAD procedures were included in the analysis. The inpatient mortality rate was lower in the high-volume centers compared with the low-volume centers (9.04% vs 18.49%, aOR 0.41, CI0.21-0.80; P = 0.009). There was a trend toward lower mortality rates in medium-volume centers compared with low-volume centers; however, it did not reach statistical significance (13.27% vs 18.49%, aOR 0.57, CI0.27-1.23; P = 0.153). Similar results were seen for major adverse events (composite of stroke/transient ischemic attack and in-hospital mortality). There was no significant difference in bleeding/transfusion, acute kidney injury, vascular complications, pericardial effusion/hemopericardium/tamponade, length of stay, cost, or 30-day readmission rates between medium- and high-volume centers compared to low-volume centers.
Conclusion: Our findings indicate lower inpatient mortality rates in high-volume LVAD implantation centers and a trend toward lower mortality rates in medium-volume LVAD implantation centers compared to lower-volume centers.
(Copyright © 2023. Published by Elsevier Inc.)
Databáze: MEDLINE
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