5 years ago

Impact of Institutional Procedural Volume on In-Hospital Outcomes After Cardiac Resynchronization Therapy Device Implantation: United States National Database 2003 – 2011

The relationship between hospital volume and outcomes for cardiac resynchronization therapy (CRT) implantations has not been well established. Objectives To examine outcomes after CRT device implantation stratified on hospital volume based on 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 in-hospital adverse events including death, cardiac perforation, pneumothorax and lead revision were examined. 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 annually. Overall complication rates were higher in the lower volume centers (3.9%, 3.5% and 3.2%; P = 0.001) when stratified by first, second and third volume tertiles, respectively. The lowest tertile of CRT volume was independently associated with increased in-hospital all-cause mortality (adjusted OR 1.37; 95% CI: 1.10 – 1.70; P = 0.005), any complication (adjusted odds ratio [OR] 1.21, 95% CI: 1.07 – 1.37; P = 0.003) and lead revision (adjusted OR 1.27; 95% CI: 1.03 – 1.58; P = 0.03). Conclusions Lower CRT hospital volume was associated with worse outcomes, including in-hospital death, overall complications and lead revision. Establishment of standards defining minimum CRT volume thresholds to identify centers of excellence may result in improved outcomes.

Publisher URL: www.sciencedirect.com/science

DOI: S1547527117310962

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