Abstract 18558: Exploring Site Level Variation in Radiation Exposure in the VA: Insights From CART
Background: Prior studies have assessed variation in radiation use and fluoroscopy times for patients undergoing coronary angiography (CA) and percutaneous coronary intervention (PCI); however, the extent that this varies by cath labs is unknown.
Methods: We analyzed data from the VA National CART Program of patients undergoing CA and PCI between 2010 and 2011 (n=28,513). Radiation exposure was measured using fluoroscopy time. We fit a mixed effects linear regression using log fluoroscopy time as outcome, a random effect for site, and adjusted for procedural and patient characteristics. Empirical Best Linear Unbiased Predictors for sites were used to estimate adjusted site level medians. The intra-class correlation (ICC) for site random effect was calculated to estimate the proportion of variance explained by site adjusting for patient and procedural characteristics. Marginal residuals were aggregated to site and examined at quarterly intervals for 2 years to establish stability of site medians over time.
Results: Overall site median fluoroscopy time was 6 minutes (IQR: 3.5, 10.2) for CA and 16.5 (IQR: 10.3,26.1) minutes for PCI. After adjusting for procedural and patient characteristics, site median fluoroscopy times ranged from 43% below to 57% above the median for CAs and 66% below to 75% above for PCIs (Figure). Sites in the top quartile of fluoroscopy time were above the overall median in 96% for CA and 99% for PCI of time periods assessed. Cath lab site accounted for a significant amount of variance in fluoroscopy times (11.9% for CA and 21.5% for PCI).
Conclusion: There is significant variation in fluoroscopy times across VA cath labs for coronary angiographies and PCIs. Even after adjustment for patient and procedures factors, there remains significant variability at the cath lab level suggesting that there may be opportunities for quality improvement interventions to reduce fluoroscopy times and radiation exposure for patients undergoing these procedures.
- © 2013 by American Heart Association, Inc.