Relation between operator and hospital volume and outcomes following percutaneous coronary interventions in the era...

Area of Science:

• Cardiology
• Health Services Research

Background:

• Studies indicate a link between procedure volume and patient outcomes for percutaneous coronary interventions (PCIs).
• The impact of coronary stents on outcomes for low-volume physicians and centers remains unclear.

Purpose of the Study:

• To evaluate the relationship between physician and hospital PCI volumes and patient outcomes.
• To assess if coronary stents mitigate outcome disparities between high- and low-volume providers.

Main Methods:

• Analysis of Medicare National Claims History data for 167,208 patients (aged 65-99) undergoing PCIs in 1997.
• Coronary stent use was recorded in 57.7% of procedures.
• Outcomes, including coronary artery bypass graft (CABG) surgery and 30-day mortality, were stratified by physician and hospital PCI volume.

Main Results:

• Low-volume physicians (<30 procedures) had higher CABG rates (2.25% vs. 1.55%) but similar 30-day mortality compared to high-volume physicians (>60 procedures).
• Low-volume hospitals (<80 procedures) had higher 30-day mortality (4.29% vs. 3.15%) but similar CABG rates compared to high-volume hospitals (>160 procedures).
• In stent recipients, low-volume centers correlated with increased mortality, while low-volume physicians correlated with increased CABG rates.

Conclusions:

• High-volume physicians and hospitals are associated with better patient outcomes following percutaneous coronary interventions.
• The experience of providers and institutions remains a critical factor in PCI success, even with advancements like coronary stents.