Abstract 16830: Effect of Operator Volume on Mortality and Complications of Carotid Artery Stenting: United States Perspective of Last 5 years
Introduction: We investigated contemporary data regarding the effect of annual operator volume on mortality and complications related to carotid artery stenting (CAS) using the largest all payer database in the US.
Methods: We examined the Nationwide Inpatient Sample (NIS) database from 2006 to 2010 using ICD 9-CM code for CAS (00.63). Only adult patients (age >18 year) with symptomatic or asymptomatic CAS (ICD 9-CM - 433.10 or 433.11) were included in study. NIS represents 20% of all US hospitals. Procedural complications were identified using Patient Safety Indicators (PSIs) and ICD-9-CM codes. Comorbid conditions were defined by Charlson’s Comorbidity Index (CCI). Annual operator and hospital volume was calculated using unique identification numbers and then divided in tertiles for analysis. Hierarchical multilevel regression models were used to determine the predictors of mortality and peri-procedural complication.
Results: Total of 13,564 (weighted n=67,344) percutaneous CAS procedures were analyzed. Mortality for symptomatic patient has reduced significantly 3.2% n 2006 vs. 1.5% in 2010 (P<0.001). Majority of complications associated with CAS were vascular (3.7%), cardiac (2.0%) and stroke (1.6%). Increased mortality (OR, 95% CI, P-value) was associated with presence of any complication (28.0, 12.13-64.61, P<0.001), symptomatic carotid stenosis (3.23, 1.42-7.35, p=0.01). Higher tertile of operator volume (0.21, 0.06-0.75, p=0.02), elective admission (0.24, 0.1-057, p<0.001) were associated with reduced mortality. Female sex (1.47, 1.23-1.76, P 2 (1.32, 1.06-1.63, p=0.01) and symptomatic carotid stenosis (2.15, 1.76-2.62, P<0.001) were associated with higher complication rate whereas Highest tertile of operator volume (0.72, 0.56-0.93, p=0.01) was associated with lower complication rate.
Conclusion: Increasing operator volume is significantly associated with of lower complication rate and lower mortality.
- © 2013 by American Heart Association, Inc.