Relationship between operator and hospital volumes and short-term mortality for percutaneous coronary intervention in...

Recent studies have reported mixed findings regarding the inverse provider volume-outcome relationship for percutaneous coronary interventions (PCIs).

We included patients who underwent PCIs in New York during December 2012-November 2015. Using risk-adjusted in-hospital/30-day mortality rate and appropriateness of PCI, we tested for a continuous relationship and a variety of annual PCI volume cut points at hospital and operator levels in investigating volume-outcome relationships.

There were 144,196 patients undergoing PCI procedures from 63 non-federal hospitals. There was a significant inverse association between risk-adjusted mortality and both annual hospital PCI volume and annual operator PCI volume. However, we did not find that there was an inverse hospital volume-outcome relationship for the 2013 ACCF/AHA/SCAI's hospital PCI volume cutoff value of 200 per year (AOR, 1.15, 95% CI, 0.88-1.51, P = 0.32) or a significant inverse operator volume-outcome relationship using the operator PCI volume cutoff value of 50 per year (AOR, 0.89, 95% CI, 0.70-1.12, P = 0.32) or for any other practical volume cutoffs. There was also no significant volume-outcome relationship for STEMI patients. Higher volume hospitals (>400) and operators (>200) tended to perform a higher percentage of inappropriate PCI procedures than their lower volume counterparts.

There were no significant PCI volume-mortality relationships for either hospitals or operators for any practical volume cuts. Higher volume hospitals and operators were associated with higher percentages of inappropriate PCIs.