Relation Between Operator and Hospital Volumes and Long-Term Outcomes for Percutaneous Coronary Intervention in New
Feng Qian1, Ye Zhong1, Edward L Hannan1
1Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany-State University of New York, Rensselaer, New York.
Insights
Higher annual hospital volume for percutaneous coronary interventions (PCI) was linked to lower mortality. However, specific volume cutoffs for hospitals and operators did not show a significant link to reduced adverse outcomes.
Area of Science:
- Cardiovascular Interventions
- Health Services Research
Background:
- The relationship between provider volume and long-term outcomes after percutaneous coronary interventions (PCI) is not well understood.
- Existing guidelines suggest minimum annual PCI volumes for hospitals and operators, but evidence for these cutoffs is limited.
Purpose of the Study:
- To investigate the association between hospital and operator annual PCI volume and 1-year adverse outcomes.
- To examine both continuous volume-outcome relationships and the impact of specific volume cutoffs.
Main Methods:
- Analysis of 34,498 PCI procedures performed in New York from December 2013 to November 2014.
- Examined continuous and cutoff-based relationships between annual hospital/operator PCI volume and 1-year mortality or mortality/acute myocardial infarction.
Main Results:
- A significant continuous inverse association was found between annual hospital PCI volume and 1-year mortality.
- No significant volume-outcome relationships were identified using established cutoffs (e.g., 200 PCI/year for hospitals, 50 PCI/year for operators).
- Providers in the highest volume quartile had lower adverse outcome rates compared to those in the lowest quartile.
Conclusions:
- No significant volume-outcome relationships were found for specific PCI volume cutoffs at the hospital or operator level.
- Continuous analysis revealed an inverse association between hospital PCI volume and mortality.
- Highest volume providers demonstrated better outcomes than lowest volume providers, suggesting a trend rather than a strict cutoff effect.
Abstract:
Little is known about whether there is an inverse relation between provider volume and long-term adverse outcomes for percutaneous coronary interventions (PCIs). For patients who underwent PCI procedures from December 2013 through November 2014 in New York, we examined a continuous relation and different annual PCI volume cut points at hospital and operator levels to investigate the relation between volume and 1-year adverse outcomes (mortality and mortality/acute myocardial infarction). There were 34,498 patients who underwent PCI procedures from 60 hospitals and 408 operators. We detected a significant continuous inverse association between 1-year mortality and annual hospital PCI volume. However, we did not find that there was a hospital volume and 1-year mortality relation for the 2013 ACCF/AHA/SCAI's hospital annual PCI volume cutoff value of 200 or a significant inverse operator volume-outcome relation using the operator annual PCI volume cutoff value of 50, or for any other practical volume cutoffs. Similar findings were obtained when we used the 1-year mortality/acute myocardial infarction outcome. We did find that providers in the highest volume quartile were associated with lower adverse outcome rates than providers in the lowest volume quartile. In conclusion, no significant volume-outcome relations were found between annual hospital or operator PCI volume and risk-adjusted 1-year outcomes for any practical volume cutoff values including 2013 Guidelines' recommended hospital/operator minimal annual PCI volumes. Providers in the highest annual volume quartile, however, were associated with lower adverse outcome rates than providers in the lowest volume quartile.
