Abstract 16152: Influence of Hospital Characteristics and Operator Volume on Adverse Outcomes of Atrial Fibrillation Ablation
Background: Utilization of Atrial Fibrillation (AF) ablation has grown exponentially over the last decade motivated by clinical trials demonstrating efficacy and safety of the procedure. Results reported by selected academic centers or operators with extensive expertise in catheter ablation may not be attained outside the context of a clinical trial. The aim of our study was to examine the impact of hospital characteristics and operator experience on in-hospital complications due to AF ablation.
Methods: Using the Nationwide Inpatient Sample (NIS) we assessed AF ablations between 2000-2010. We investigated in-hospital complications including pericardial tamponade, stroke, transient ischemic attack, vascular access complications and death. We stratified hospitals by its bed size, location, teaching status, region of the country and the annual AF ablation volume as more than 100, between 50-100, and less than 50. We divided annual operator volume as more than 50 procedures, between 50-25 and less than 25.
Results: 93801 AF ablations were identified between the years 2000-2010. The overall frequency of complications was 6.29%. Most procedures were performed in hospitals which were large (79%), urban (98.1%), academic (70.8%) and located in south (31.6%). 68.2% of the procedures were performed in low volume (<50 annual procedures) hospitals and 81% of procedures were performed by operators doing less than 25 AF ablations a year. On creating multiple models for independent predictors of complications, the hospital volume and operator volume were significantly associated with higher in-hospital complications (Table).
Conclusion: In the largest sample of AF ablations reported thus far, we found a significant association between operator and hospital volume on adverse outcomes. This suggests a need for future research into defining competency for this ablation procedure, and instituting appropriate interventions to improve overall AF ablation outcomes.
- © 2013 by American Heart Association, Inc.