Abstract 18241: Impact of Annual Hospital Volume on In-Hospital Outcomes After Cardiac Transplantation
Introduction: Limited evidence exists regarding the impact of annual hospital volume on outcomes in patients receiving heart transplant.
Hypothesis: To quantify the impact of annual hospital volume on in-hospital mortality among patients receiving heart transplantation.
Methods: Data from the National (Nationwide) Inpatient Sample (years 2008 to 2012) were analyzed to identify 11,104 patients receiving heart transplant. The study population was identified using validated international Classification of Diseases, Ninth Revision, Clinical Modification diagnosis (ICD-9-CM) and procedure codes. Annual hospital volume was calculated using unique hospital identifiers. Hospitals were divided into tertiles based on the volume of transplant cases admitted over the study period (low: 1-65, medium: 65-125, high> 125). Multivariate regression analysis was used to identify independent predictors of mortality in patients undergoing heart transplant.
Results: Between the years of 2008 and 2012, a total of 519 (4.67%) in-hospital deaths occurred among recipients of heart transplantation. In-hospital mortality was highest (5.8%) in the low hospital volume and lowest (3.9%) in hospitals with high annual volume (p<0.001). Multivariate analysis revealed that patient age (OR 1.021, 95% CI, 1.01-1.02, p<0.001), history of liver disease (OR 1.9, 95%CI 1.65-2.38, p<0.001), diabetes (OR 1.5, 95% 1.12-2.0, p=0.006) and stroke (OR 5.01 95% CI 3.8-6.4, p<0.001) were independently associated with higher in-hospital mortality. Additionally, hospital volume was an independent predictor of mortality with the adjusted odds ratio for inpatient mortality for persons admitted to medium and high hospital volumes being 0.73 (95% CI, 0.46-0.96, P=0.005) and 0.65 (95% CI, 0.4-0.86, p<0.001), respectively.
Conclusion: Hospital volume is an independent determinant for in-hospital mortality among patient receiving heart transplants.
Author Disclosures: K. Moazzami: None. E. Dolmatova: None. J.M. Maher: None. P. Solanki: None. M. Klapholz: None. A.H. Waller: None.
- © 2016 by American Heart Association, Inc.