Physician procedure volume and complications of cardioverter-defibrillator implantation

Area of Science:

• Cardiology
• Medical Device Procedures
• Health Outcomes Research

Background:

• Physician experience is linked to improved procedural outcomes.
• The impact of physician procedure volume on implantable cardioverter-defibrillator (ICD) complications requires investigation.

Purpose of the Study:

• To assess the relationship between physician annual ICD implantation volume and in-hospital complication rates.
• To determine if physician experience influences patient safety during ICD placement.

Main Methods:

• Analysis of 356,515 initial ICD implantations from the National Cardiovascular Data Registry-ICD Registry.
• Hierarchical logistic regression used to analyze physician volume and complication rates, adjusting for patient, physician, and hospital factors.
• Subgroup analysis conducted for single chamber, dual chamber, and biventricular ICD subtypes.

Main Results:

• A significant inverse relationship was found between physician ICD volume and complication rates (P<0.0001).
• Complication rates decreased from 4.6% in the lowest quartile to 2.9% in the highest physician volume quartile.
• In-hospital mortality also decreased with increasing physician volume (0.72% to 0.36%, P<0.0001).

Conclusions:

• Higher physician volume of ICD implantations is associated with lower procedural complication and mortality rates.
• This relationship is independent of hospital volume, physician specialty, and ICD type.
• Increased physician experience in ICD procedures enhances patient safety and outcomes.