Abstract 15618: PCI Outcomes among Medicare Beneficiaries during Fiscal Year 2010 at Hospitals with and without Cardiac Surgery On-Site
Objective: The trend toward allowing PCI to be performed without on-site surgical backup (non-SOS) continues to be controversial. The purpose of this analysis is to report average risk-adjusted hospital outcomes for PCI among non-SOS hospitals and with surgical backup on-site (SOS).
Methods: This retrospective study examined fiscal year 2010 MedPar Files to identify all hospital admissions where a Medicare Beneficiary (MB) underwent PCI without CABG or valve surgery. MBs were deleted from the sample if they were transferred to another acute care hospital or if a hospital did not perform 52 PCIs during the study period. A total of 66 SOS hospitals and 334 non-SOS hospitals did not perform 52 PCIs. The final study population consists of 322,176 admissions in 1,297 US hospitals. ICD-9-CM codes were used to identify adverse outcomes and co-morbidities. Clinical outcomes of interest include: in-hospital mortality, new onset hemodialysis, and any vascular complications. Separate risk-adjusted models were estimated for outcome controlling of up to 25 demographic and cardiovascular risk factors. Risk-adjusted outcomes were calculated for each hospital, by type of hospital.
Findings: The table indicates that 1,297 hospitals preformed at least 52 PCI on MBs during FY 2010, of which all but 197 hospitals had surgical backup on site. Average hospital volume among SOS hospitals was significantly higher than among those non-SOS hospitals. Each of the three average risk-adjusted outcomes indicated that adverse events were lower in non-SOS hospitals than in SOS hospitals; however, these differences were only significantly different for any vascular complications (4.38% versus 5.10%, p=0.002).
Conclusions: This retrospective study confirms that clinical outcomes for PCI in non-SOS hospitals that performed at least 52 interventions per year are similar to the average outcomes performed in SOS hospitals.
- © 2012 by American Heart Association, Inc.