Abstract 16628: Effect of Hospital Procedure Volume on In-Hospital Mortality After Left Ventricular Assist Device (LVAD) Implantation in Advanced Heart Failure Patients From 1998 to 2010: An Analysis of 10,251 Procedures
Background: LVAD is used either as destination therapy (DT) or bridge to transplant (BTT) in patients with advanced heart failure. We aim to examine if any relation exists between hospital volume and mortality using nationwide inpatient sample (NIS), nation’s largest all payer database.
Methods: We queried NIS from 1998 to 2010 using ICD-9 procedure code of 37.66 for LVAD. Patients >18 years without primary diagnosis of cardiogenic shock or acute myocardial infarction or heart transplant were included. Annual hospital procedure volume was computed using the unique hospital identification number (ID) and was divided into tertiles corresponding to 1-8, 9-21 and 22-57 procedures per year. Burden of comorbid conditions was assessed using Charlson comorbidity index (CCI). Primary outcome was in-hospital mortality. We built a hierarchical two level model adjusted for multiple confounding factors, with hospital ID incorporated as random effects in the model.
Results: A total of 2,025 procedures (weighted n=10,251) were available for analysis. Overall in-hospital mortality was 26.5%. There was a decrease in mortality from 43.3% deaths in first tertile to 23% deaths in the second tertile and 11.9% deaths in third tertile of hospital volume. In a multivariate hierarchical model, hospital volume was an independent predictor of decreased in-hospital mortality. The adjusted odds ratio of the second tertile of hospital volume compared to the first tertile was 0.35 (95% confidence interval (CI) 0.25-0.48, p<0.001). The adjusted odds ratio of the third tertile of hospital volume compared to the first tertile was 0.16 (95% CI 0.11-0.24, p<0.001).
Conclusions: Our results indicate that high annual hospital procedure volume is independently associated with decreased in-hospital mortality after LVAD implantation in advanced heart failure patients. Thus, establishing critical hospital volume thresholds would improve outcomes and efficiency of care after LVAD implantation.
- © 2013 by American Heart Association, Inc.