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Relationship Between Operator Volume and Long-Term Outcomes After Percutaneous Coronary Intervention.
- Source :
-
Circulation . 1/22/2019, Vol. 139 Issue 4, p458-472. 15p. - Publication Year :
- 2019
-
Abstract
- <bold>Background: </bold>Although many studies show an inverse association between operator procedural volume and short-term adverse outcomes after percutaneous coronary intervention (PCI), the association between procedural volume and longer-term outcomes is unknown.<bold>Methods: </bold>Using the National Cardiovascular Data Registry CathPCI registry data linked with Medicare claims data, we examined the association between operator PCI volume and long-term outcomes among patients ≥65 years of age. Operators were stratified by average annual PCI volume (counting PCIs performed in patients of all ages): low- (<50 PCIs), intermediate- (50-100), and high- (>100) volume operators. One-year unadjusted rates of death and major adverse coronary events (MACEs; defined as death, readmission for myocardial infarction, or unplanned coronary revascularization) were calculated with Kaplan-Meier methods. The proportional hazards assumption was not met, and risk-adjusted associations between operator volume and outcomes were calculated separately from the time of PCI to hospital discharge and from hospital discharge to 1-year follow-up.<bold>Results: </bold>Between July 1, 2009, and December 31, 2014, 723 644 PCI procedures were performed by 8936 operators: 2553 high-, 2878 intermediate-, and 3505 low-volume operators. Compared with high- and intermediate-volume operators, low-volume operators more often performed emergency PCI, and their patients had fewer cardiovascular comorbidities. Over 1-year follow-up, 15.9% of patients treated by low-volume operators had a MACE compared with 16.9% of patients treated by high-volume operators ( P=0.004). After multivariable adjustment, intermediate- and high-volume operators had a significantly lower rate of in-hospital death than low-volume operators (odds ratio, 0.91; 95% CI, 0.86-0.96 for intermediate versus low; odds ratio, 0.79; 95% CI, 0.75-0.83 for high versus low). There were no significant differences in rates of MACEs, death, myocardial infarction, or unplanned revascularization between operator cohorts from hospital discharge to 1-year follow-up (adjusted hazard ratio for MACEs, 0.99; 95% CI, 0.96-1.01 for intermediate versus low; hazard ratio, 1.01; 95% CI, 0.99-1.04 for high versus low).<bold>Conclusions: </bold>Unadjusted 1-year outcomes after PCI were worse for older adults treated by operators with higher annual volume; however, patients treated by these operators had more cardiovascular comorbidities. After risk adjustment, higher operator volume was associated with lower in-hospital mortality and no difference in postdischarge MACEs. [ABSTRACT FROM AUTHOR]
- Subjects :
- *PERCUTANEOUS coronary intervention
*HOSPITAL admission & discharge
*MYOCARDIAL revascularization
*HOSPITAL mortality
*OLDER people
*MYOCARDIAL infarction
*ENDARTERECTOMY
*CARDIOVASCULAR system
*COMPARATIVE studies
*DATABASES
*HOSPITALS
*RESEARCH methodology
*MEDICAL care
*EVALUATION of medical care
*MEDICAL cooperation
*MEDICARE
*REOPERATION
*RESEARCH
*TIME
*EMPLOYEES' workload
*EVALUATION research
*TREATMENT effectiveness
*ACQUISITION of data
*RETROSPECTIVE studies
*PATIENT readmissions
Subjects
Details
- Language :
- English
- ISSN :
- 00097322
- Volume :
- 139
- Issue :
- 4
- Database :
- Academic Search Index
- Journal :
- Circulation
- Publication Type :
- Academic Journal
- Accession number :
- 135697364
- Full Text :
- https://doi.org/10.1161/CIRCULATIONAHA.117.033325