TY  - BOOK
AU  - Chothani, Ankit
TI  - Impact of annual operator and institutional volume on percutaneous coronary intervention outcomes: a 5-year United States experience (2005-2009)
SN  - 0009-7322
PY  - 2014///
KW  - *Coronary Artery Disease/mo [Mortality]
KW  - *Coronary Artery Disease/th [Therapy]
KW  - *Hospital Mortality
KW  - *Hospitals, High-Volume/sn [Statistics & Numerical Data]
KW  - *Hospitals, Low-Volume/sn [Statistics & Numerical Data]
KW  - *Percutaneous Coronary Intervention/mo [Mortality]
KW  - Aged
KW  - Cross-Sectional Studies
KW  - Databases, Factual/sn [Statistics & Numerical Data]
KW  - Female
KW  - Humans
KW  - Length of Stay/sn [Statistics & Numerical Data]
KW  - Male
KW  - Middle Aged
KW  - Multivariate Analysis
KW  - Percutaneous Coronary Intervention/ae [Adverse Effects]
KW  - Risk Assessment
KW  - United States/ep [Epidemiology]
KW  - MedStar Washington Hospital Center
KW  - Medicine/General Internal Medicine
N1  - Available online from MWHC library: 1950 - present, Available in print through MWHC library: 1999 - 2006
N2  - BACKGROUND: The relationship between operator or institutional volume and outcomes among patients undergoing percutaneous coronary interventions (PCI) is unclear; CONCLUSIONS: Overall in-hospital mortality after PCI was low. An increase in operator and institutional volume of PCI was found to be associated with a decrease in adverse outcomes, length of hospital stay, and cost of hospitalization.Copyright � 2014 American Heart Association, Inc; 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(th) 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(th) [annual procedural volume; primary and secondary outcomes] [>100; 0.59% and 5.51%], 3(rd) [45-100; 0.87% and 6.40%], and 2(nd) quartile [16-44; 1.15% and 7.75%] were significantly less (P<0.001) when compared with those by operators in the 1(st) quartile [<15; 1.68% and 10.91%]. Spline analysis also showed significant operator and institutional volume outcome relationship. Similarly operators in the higher quartiles witnessed a significant reduction in length of hospital stay and cost of hospitalization (P<0.001)
UR  - http://dx.doi.org/10.1161/CIRCULATIONAHA.114.009281
ER  -