Abstract 13422: Patient, Operator, and Hospital Determinants of Fluoroscopy Time for Left Heart Catheterization and Percutaneous Coronary Intervention: Insights from the NCDR®
Background: Left heart catheterization (LHC) and percutaneous coronary intervention (PCI) are significant contributors to radiation exposure from medical imaging in the US. Fluoroscopy time is a key determinant of radiation dose for these procedures. The distribution and patient-, operator-, and hospital-level determinants of fluoroscopy time for LHC and PCI have not been well characterized.
Methods: We evaluated the distribution of fluoroscopy time in patients undergoing LHC and/or PCI in the Cath-PCI Registry®. Hierarchical models were used to determine patient, operator and hospital characteristics associated with fluoroscopy time for these procedures. Fractional polynomials regression was used to further assess the relationship between operator volume and fluoroscopy time.
Results: Our study included a total of 3,295,348 LHC and PCI procedures performed by 33,632 operators at 942 facilities from 2005 through 2009. There was wide variation among operators in fluoroscopy times for these procedures (Table, part I). Operator volume was inversely related to fluoroscopy time, even after accounting for patient and procedure characteristics. After multivariable adjustment, factors associated with the largest increment in LHC and PCI fluoroscopy time included brachial or radial arterial access, concomitant right heart catheterization, and a university hospital setting (Table, part II). For PCI, intraprocedural complications (including coronary dissection, perforation, and acute closure), complex lesion anatomy (class C or bifurcation lesions), and number of lesions intervened upon were also associated with substantially increased fluoroscopy times.
Conclusion: Operator- and hospital-related factors, including operator volume, have a significant impact on LHC and PCI fluoroscopy time. A better understanding of these sources of variation in fluoroscopy time may elucidate opportunities for enhancing radiation safety of these procedures.
- © 2011 by American Heart Association, Inc.