Effect of Hospital Volume on Outcomes of Transcatheter Aortic Valve Implantation.

MedStar author(s):
Citation: American Journal of Cardiology. 116(4):587-94, 2015 Aug 15.PMID: 26092276Institution: MedStar Washington Hospital CenterDepartment: Medicine/General Internal MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Valve Stenosis/su [Surgery] | *Health Care Costs | *Transcatheter Aortic Valve Replacement/sn [Statistics & Numerical Data] | Aged, 80 and over | Aortic Valve Stenosis/ec [Economics] | Aortic Valve Stenosis/mo [Mortality] | Cross-Sectional Studies | Databases, Factual | Female | Hospital Mortality | Hospitalization/ec [Economics] | Hospitalization/sn [Statistics & Numerical Data] | Humans | Logistic Models | Male | Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Transcatheter Aortic Valve Replacement/ec [Economics] | Treatment OutcomeYear: 2015Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0002-9149
Name of journal: The American journal of cardiologyAbstract: Transcatheter aortic valve implantation (TAVI) is associated with a significant learning curve. There is paucity of data regarding the effect of hospital volume on outcomes after TAVI. This is a cross-sectional study based on Healthcare Cost and Utilization Project's Nationwide Inpatient Sample database of 2012. Subjects were identified by International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes, 35.05 (Trans-femoral/Trans-aortic Replacement of Aortic Valve) and 35.06 (Trans-apical Replacement of Aortic Valve). Annual hospital TAVI volumes were calculated using unique identification numbers and then divided into quartiles. Multivariate logistic regression models were created. The primary outcome was inhospital mortality; secondary outcome was a composite of inhospital mortality and periprocedural complications. Length of stay (LOS) and cost of hospitalization were assessed. The study included 1,481 TAVIs (weighted n = 7,405). Overall inhospital mortality rate was 5.1%, postprocedural complication rate was 43.4%, median LOS was 6 days, and median cost of hospitalization was All authors: Arora S, Badheka AO, Chothani A, Cleman M, Curtis J, Deshmukh A, Dhoble A, Forrest JK, Grines CL, Jhamnani S, Mangi AA, Manvar S, Panaich SS, Pant S, Patel A, Patel J, Patel N, Patel N, Patel NJ, Patel SV, Savani C, Savani GT, Singh V, Thakkar BFiscal year: FY2016Digital Object Identifier: Date added to catalog: 2016-01-13
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Journal Article MedStar Authors Catalog Article 26092276 Available 26092276

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

Transcatheter aortic valve implantation (TAVI) is associated with a significant learning curve. There is paucity of data regarding the effect of hospital volume on outcomes after TAVI. This is a cross-sectional study based on Healthcare Cost and Utilization Project's Nationwide Inpatient Sample database of 2012. Subjects were identified by International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes, 35.05 (Trans-femoral/Trans-aortic Replacement of Aortic Valve) and 35.06 (Trans-apical Replacement of Aortic Valve). Annual hospital TAVI volumes were calculated using unique identification numbers and then divided into quartiles. Multivariate logistic regression models were created. The primary outcome was inhospital mortality; secondary outcome was a composite of inhospital mortality and periprocedural complications. Length of stay (LOS) and cost of hospitalization were assessed. The study included 1,481 TAVIs (weighted n = 7,405). Overall inhospital mortality rate was 5.1%, postprocedural complication rate was 43.4%, median LOS was 6 days, and median cost of hospitalization was 1,975. Inhospital mortality rates decreased with increasing hospital TAVI volume with a rate of 6.4% for lowest volume hospitals (first quartile), 5.9% (second quartile), 5.2% (third quartile), and 2.8% for the highest volume TAVI hospitals (fourth quartile). Complication rates were significantly higher in hospitals with the lowest volume quartile (48.5%) compared to hospitals in the second (44.2%), third (39.7%), and fourth (41.5%) quartiles (p <0.001). Increasing hospital volume was independently predictive of shorter LOS and lower hospitalization costs. In conclusion, higher annual hospital volumes are significantly predictive of reduced postprocedural mortality, complications, shorter LOS, and lower hospitalization costs after TAVI. Copyright � 2015 Elsevier Inc. All rights reserved.

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