TY - JOUR
T1 - Impact of institutional procedural volume on inhospital outcomes after cardiac resynchronization therapy device implantation
T2 - US national database 2003–2011
AU - Yeo, Ilhwan
AU - Kim, Luke K.
AU - Lerman, Bruce B.
AU - Cheung, Jim W.
N1 - Publisher Copyright:
© 2017 Heart Rhythm Society
PY - 2017/12
Y1 - 2017/12
N2 - Background The relationship between hospital volume and outcomes for cardiac resynchronization therapy (CRT) implantations has not been well established. Objective The purpose of this study was to examine outcomes after CRT device implantation stratified by hospital volume using a large national inpatient database. Methods Using the National Inpatient Sample database, we identified all patients undergoing de novo CRT implants between 2003 and 2011. Hospitals were categorized according to tertiles of annual CRT procedural volume. Rates of inhospital adverse events including death, cardiac perforation, pneumothorax, and lead revision were examined. A multivariate logistic regression analysis was performed to compare outcomes across hospital volume categories. Results Between 2003 and 2011, 410,104 de novo CRT implantations were performed. More than half (50.9%) of hospitals performed ≤16 CRT implants/y. Overall complication rates were higher in the lower-volume centers (3.9%, 3.5%, and 3.2%; P =.001) when stratified by first, second, and third tertiles of CRT volume, respectively. The lowest tertile of CRT volume was independently associated with increased inhospital all-cause mortality (adjusted odds ratio [OR] 1.37; 95% confidence interval [CI] 1.10–1.70; P =.005), any complication (adjusted OR 1.21, 95% CI 1.07–1.37; P =.003), and lead revision (adjusted OR 1.27; 95% CI 1.03–1.58; P =.03). Conclusion Lower CRT hospital volume was associated with worse outcomes, including inhospital death, overall complications, and lead revision. Establishment of standards defining minimum CRT volume thresholds to identify centers of excellence may result in improved outcomes.
AB - Background The relationship between hospital volume and outcomes for cardiac resynchronization therapy (CRT) implantations has not been well established. Objective The purpose of this study was to examine outcomes after CRT device implantation stratified by hospital volume using a large national inpatient database. Methods Using the National Inpatient Sample database, we identified all patients undergoing de novo CRT implants between 2003 and 2011. Hospitals were categorized according to tertiles of annual CRT procedural volume. Rates of inhospital adverse events including death, cardiac perforation, pneumothorax, and lead revision were examined. A multivariate logistic regression analysis was performed to compare outcomes across hospital volume categories. Results Between 2003 and 2011, 410,104 de novo CRT implantations were performed. More than half (50.9%) of hospitals performed ≤16 CRT implants/y. Overall complication rates were higher in the lower-volume centers (3.9%, 3.5%, and 3.2%; P =.001) when stratified by first, second, and third tertiles of CRT volume, respectively. The lowest tertile of CRT volume was independently associated with increased inhospital all-cause mortality (adjusted odds ratio [OR] 1.37; 95% confidence interval [CI] 1.10–1.70; P =.005), any complication (adjusted OR 1.21, 95% CI 1.07–1.37; P =.003), and lead revision (adjusted OR 1.27; 95% CI 1.03–1.58; P =.03). Conclusion Lower CRT hospital volume was associated with worse outcomes, including inhospital death, overall complications, and lead revision. Establishment of standards defining minimum CRT volume thresholds to identify centers of excellence may result in improved outcomes.
KW - Cardiac resynchronization therapy
KW - Complications
KW - Hospital volume
KW - Lead revision
KW - Mortality
UR - http://www.scopus.com/inward/record.url?scp=85031916153&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2017.09.017
DO - 10.1016/j.hrthm.2017.09.017
M3 - Article
C2 - 28917564
AN - SCOPUS:85031916153
SN - 1547-5271
VL - 14
SP - 1826
EP - 1832
JO - Heart Rhythm
JF - Heart Rhythm
IS - 12
ER -