Abstract 16998: Impact of Annual Operator Volume on Percutaneous Coronary Intervention Outcomes: A United States Experience From 2,243,209 procedures
Introduction: Percutaneous coronary intervention (PCI) volume is often used as a surrogate to define quality and maintain proficiency (> 75 PCI/year). Currently there lacks definite evidence to support the role of annual operator caseload in predicting in-hospital mortality (IHM) and peri-procedural complications (PPC).
Method: We queried the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample between 2005-2010 using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure code, 36.06 and 36.07 for PCI. Only patients >18 years of age were included. Primary outcome was IHM and secondary outcome was composite of IHM and PPC. PPC were identified using Patient Safety Indicators (PSIs) and ICD-9-CM codes. Comorbid conditions were defined using the Deyo modification of Charlson’s Comorbidity Index (CCI). Annual operator and hospital volume was calculated using unique identification numbers and then divided into quartiles for analysis. Three level hierarchial multivariate mixed models were created. Discrimination power of the models was assessed using the c-index.
Results: 2,243,209 procedures were identified. Overall mortality was 1.1%, complication rate were 7.1%. With increasing operator caseload quartiles there was a significant trend of decreasing IHM and PPC (see figure). Independent predictors of primary and secondary outcomes were any complication (p<0.001), age (p<0.001), female sex (p<0.001), presence of shock (p<0.001), myocardial infarction (p<0.001), urgent/emergent admission (<0.001), use of assist devise (<0.001) and CCI ≥ 1 (p<0.001). With increasing operator volume there was significant decrease in IHM & PPC (see figure). C-index was reported at 0.93 (0.92-0.93) for primary & 0.75 (0.74-0.75) for secondary outcome.
Conclusion: Increasing operator volume experience is associated with a decrease in PCI related in-hospital mortality and procedural complications.
- © 2013 by American Heart Association, Inc.