Impact of Annual Operator and Institutional Volume on Percutaneous Coronary Intervention Outcomes: A 5-Year United States Experience (2005–2009)

• Published in: Circulation (New York, N.Y.) N.Y.), 2014-10, Vol.130 (16), p.1392-1406
• Main Authors: Badheka, Apurva O, Patel, Nileshkumar J, Grover, Peeyush, Singh, Vikas, Patel, Nilay, Arora, Shilpkumar, Chothani, Ankit, Mehta, Kathan, Deshmukh, Abhishek, Savani, Ghanshyambhai T, Patel, Achint, Panaich, Sidakpal S, Shah, Neeraj, Rathod, Ankit, Brown, Michael, Mohamad, Tamam, Tamburrino, Frank V, Kar, Saibal, Makkar, Raj, O’Neill, William W, De Marchena, Eduardo, Schreiber, Theodore, Grines, Cindy L, Rihal, Charanjit S, Cohen, Mauricio G
• Format: Article
• Language: English
• Subjects: Aged; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Cross-Sectional Studies; Databases, Factual - statistics & numerical data; Female; Hospital Mortality; Hospitals, High-Volume - statistics & numerical data; Hospitals, Low-Volume - statistics & numerical data; Humans; Length of Stay - statistics & numerical data; Male; Middle Aged; Multivariate Analysis; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - mortality; Risk Assessment; United States - epidemiology
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.114.009281

BACKGROUND—The relationship between operator or institutional volume and outcomes among patients undergoing percutaneous coronary interventions (PCI) is unclear. METHODS AND RESULTS—Cross-sectional study based on the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample between 2005 to 2009. Subjects were identified by International Classification of Diseases, 9 Revision, Clinical Modification procedure code, 36.06 and 36.07. Annual operator and institutional volumes were calculated using unique identification numbers and then divided into quartiles. Three-level hierarchical multivariate mixed models were created. The primary outcome was in-hospital mortality; secondary outcome was a composite of in-hospital mortality and peri-procedural complications. A total of 457 498 PCIs were identified representing a total of 2 243 209 PCIs performed in the United States during the study period. In-hospital, all-cause mortality was 1.08%, and the overall complication rate was 7.10%. The primary and secondary outcomes of procedures performed by operators in 4 [annual procedural volume; primary and secondary outcomes] [>100; 0.59% and 5.51%], 3 [45–100; 0.87% and 6.40%], and 2 quartile [16–44; 1.15% and 7.75%] were significantly less (P