Abstract 16931: Influence of Operator Volume on Length of Stay After Percutaneous Carotid Artery Stenting: A 5 Year United States Perspective of 67,344 Procedures
Introduction: We assessed the influence of annual operator volume on length of stay (LOS) after carotid artery stenting (CAS) in the US from 2006-2010.
Methods: We examined the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) database from 2006 to 2010 using ICD-9-CM code for percutaneous carotid artery stenting (00.63). Only adult (age>18 years) patients with symptomatic or asymptomatic carotid artery stenosis (ICD-9-CM 433.10 or 433.11) were included in study. NIS represents 20% of all US hospitals.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. Complications were defined by ICD-9 codes or Patient Safety Indicators. Hierarchical multilevel regression models were generated to determine independent predictors of LOS.
Results: Total of 13,564 (weighted n=67,344) percutaneous CAS procedures were analyzed. LOS for symptomatic patients has decreased from 6.1 days in 2006 to 4.3 days in 2010 (p<0.05). LOS for asymptomatic patient has remained plateaued at around 2.0 days over 5 years. Higher LOS (days, 95% CI, P-value) was associated with presence of any complication (+2.48 days, 2.20-2.76, P<0.001), symptomatic presentation (+1.30 days, 1.11-1.50, p<0.001), weekend admission (+2.29 days, 1.88-2.70, P<0.001), and CCI 2 or more (+0.76 days, 0.58-0.94, P<0.001). Lower LOS was associated with increase in yearly operator volume (-1.17 days per unit increase, -1.40 to -0.94, P<0.001), private insurance status (-0.24 days, -0.44 to -0.03, p=0.02) and elective admission (-2.34 days, -2.54 to -2.14, P<0.001).
Conclusion: Length of stay after percutaneous carotid artery stenting has decreased over the years from 2006 to 2010 for those with symptomatic presentation. Symptomatic presentation is associated with higher LOS and high annual operator volume is associated with lower LOS.
- © 2013 by American Heart Association, Inc.