Impact of Institutional Volume on Outcomes of Catheter Directed Thrombolysis in the Treatment of Acute Proximal Deep Vein Thrombosis: A 6-Year United States Experience (2005-2010)
Background—Utilization of catheter directed thrombolysis (CDT) in treatment of acute proximal lower extremity deep vein thrombosis (LE-DVT) is increasing in the United States and has been linked to higher bleeding rates. Whether this relationship is interrelated with institution volume of CDT is unknown.
Methods and Results—The Nationwide Inpatient Sample (NIS) database was used to identify all patients admitted with a principal diagnosis of proximal or inferior vena caval DVT and treated with CDT from 2005 to 2010. Institutions were divided into high (≥6 procedures a year) and low volume centers (<6 procedures a year). Propensity score matching was used to create two matched groups for comparative analysis. A total of 90 618 patients were hospitalized for proximal LE-DVT and 3649 patients (4.1%) underwent CDT. In-hospital mortality was significantly lower at high volume centers (0.6% vs. 1.5%; P= 0.04) with a trend towards lower intracranial hemorrhage rates compared to low volume centers (0.4% vs. 1%; P= 0.07). No significant difference was seen with blood transfusion (10.4% vs. 10.8%. P= 0.70), gastrointestinal bleeding (1.4% vs. 1.8% P= 0.35) or pulmonary embolism rates (18.4% vs. 17.9% P= 0.72). Median length of stay was similar (6 days) and hospital charges were higher at high volume centers ($65500 vs. $75870).
Conclusions—In this observational study we found that an increase in institutional volumes of CDT was associated with lower in-hospital mortality as well as lower intracranial hemorrhage rates. Further studies are needed to assess whether standardization of CDT protocols across all institutions in the United States improves outcomes.
- catheter directed thrombolysis
- catheter-based non coronary interventions
- Received January 18, 2015.
- Revision received July 7, 2015.
- Accepted July 16, 2015.