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Inpatient mortality and its predictors after pericardiocentesis: An analysis from the Nationwide Inpatient Sample
Ankur Sethi1, Yash Singbal2, Vamsi Kodumuri3
1RutgersRobert Wood Johnson Medical School, New Brunswick, New Jersey.
Insights
Inpatient mortality after pericardiocentesis is high, especially when linked to percutaneous coronary intervention (PCI) and structural heart interventions (SHI). Higher hospital procedural volume is associated with lower inpatient mortality rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Limited data exists on in-hospital outcomes and predictors following pericardiocentesis, primarily from single-center studies.
- Outcomes for iatrogenic pericardial effusion and the impact of procedural volume on outcomes remain largely unknown.
- National registries offer valuable insights into cardiac procedure outcomes.
Purpose of the Study:
- To estimate inpatient outcomes after pericardiocentesis in the United States.
- To analyze outcomes in patients with iatrogenic pericardial effusion.
- To investigate the impact of hospital procedural volume on inpatient mortality.
Main Methods:
- Utilized the National Inpatient Sample database from 2009-2013.
- Analyzed inpatient outcomes for all pericardiocentesis procedures and specific subgroups.
- Assessed the association between hospital procedural volume and inpatient mortality.
Main Results:
- Over 64,000 pericardiocentesis procedures were performed between 2009-2013.
- Overall inpatient mortality was 12.30%, with higher rates for percutaneous coronary intervention (PCI) and structural heart interventions (SHI).
- Higher hospital procedural volume demonstrated an inverse association with inpatient mortality (p<0.001).
Conclusions:
- Inpatient mortality following pericardiocentesis is substantial.
- Mortality is particularly elevated when pericardiocentesis is associated with PCI and SHI.
- Hospital procedural volume is a significant predictor of inpatient mortality.
Background:
National registries have provided data on in-hospital outcomes for several cardiac procedures. The available data on in-hospital outcomes and its predictors after pericardiocentesis are mostly derived from single center studies. Furthermore, the outcomes after pericardiocentesis for iatrogenic pericardial effusion and the impact of procedural volume on in-hospital outcomes in the United States are largely unknown.
Methods:
We used national inpatient database files for the years 2009-2013 to estimate the inpatient outcomes after pericardiocentesis in all-comers and in the subgroups with iatrogenic effusion. We also studied the impact of hospital procedural volume, among other predictors, on inpatient mortality.
Results:
About 64,070 (95%CI 61 008-67 051) pericardiocentesis were performed in the United States during 2009-2013. Of these, 57.15% (56.02-58.26%) of the pericardiocentesis were in hemodynamically unstable patients. Percutaneous cardiac procedures were performed in 17.7% of patients (percutaneous coronary intervention (PCI) 4.02%, electrophysiologic procedures 13.58%, and structural heart intervention (SHI) 0.76%). Overall inpatient mortality was 12.30% (95%CI 11.66-12.96%). Inpatient mortality after PCI, electrophysiologic procedures, SHI and cardiac surgery were 27.67% (95%CI 24-31.67%), 7.8% (95%CI 6.67-9.31%), 22.36% (95%CI 15.06-31.85%) and 18.97% (95%CI 15.84-22.57%), respectively. There was an inverse association between hospital procedural volume and inpatient mortality, with a mortality of 14.01% (12.84-15.26%) at the lowest and 10.82% (9.44-12.37%) at highest quartile hospitals by procedure volume (ptrend = 0.001).
Conclusion:
The inpatient mortality after pericardiocentesis is high, particularly when associated with PCI and SHI.
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