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Published on: February 26, 2013
Association of Hospital Procedural Volume With Outcomes of Percutaneous Left Atrial Appendage Occlusion
Salik Nazir1, Keerat Rai Ahuja2, Dhaval Kolte3
1Division of Cardiology, University of Toledo Medical Center, Toledo, Ohio, USA.
Insights
Higher procedural volume in left atrial appendage occlusion (LAAO) procedures is linked to better in-hospital outcomes. This study found lower major adverse events in high-volume hospitals, suggesting a volume-outcome relationship for LAAO.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- A known inverse volume-outcome relationship exists for many invasive cardiac procedures.
- The association between hospital procedural volume and outcomes for left atrial appendage occlusion (LAAO) is not well-established.
Purpose of the Study:
- To investigate the relationship between the volume of percutaneous left atrial appendage occlusion (LAAO) procedures performed at a hospital and in-hospital patient outcomes.
Main Methods:
- Analysis of 5,949 LAAO procedures from the 2017 Nationwide Readmissions Database.
- Hospitals were stratified into low, medium, and high annual procedural volume tertiles.
- Multivariate logistic regression and restricted cubic spline analyses assessed the association between hospital LAAO volume and in-hospital major adverse events (MAE).
Main Results:
- Low-volume hospitals exhibited significantly higher rates of in-hospital MAE (9.5%), stroke/TIA (2.1%), and bleeding/transfusion (6.1%) compared to high-volume hospitals.
- Higher procedural volume was independently associated with reduced in-hospital MAE (adjusted OR for high vs. low volume: 0.55; P=0.003).
Conclusions:
- Increased hospital procedural volume for LAAO is associated with improved in-hospital outcomes.
- Further research is warranted to confirm this association for long-term outcomes.
Objectives:
The aim of this study was to examine the association between percutaneous left atrial appendage occlusion (LAAO) procedural volume and in-hospital outcomes.
Background:
Several studies have demonstrated an inverse volume-outcome relationship for patients undergoing invasive cardiac procedures. Whether a similar association exists for percutaneous LAAO remains unknown.
Methods:
Patients undergoing LAAO in 2017 were identified in the Nationwide Readmissions Database. Hospitals were categorized into 3 groups on the basis of tertiles of annual procedural volume: low (5 to 15 cases/year), medium (17 to 31 cases/year), and high (32 to 211 cases/year). Multivariate hierarchical logistic regression and restricted cubic spline analyses were performed to examine the association of hospital LAAO volume and outcomes. The primary outcome was in-hospital major adverse events (MAE), defined as a composite of mortality, stroke or transient ischemic attack, bleeding or transfusion, vascular complications, myocardial infarction, systemic embolization, and pericardial effusion or tamponade requiring pericardiocentesis or surgery.
Results:
This study included 5,949 LAAO procedures performed across 196 hospitals with a median annual procedural volume of 41 (interquartile range: 25 to 67). Low-volume hospitals had higher rates of in-hospital MAE (9.5% vs. 5.6%; p < 0.001), stroke or transient ischemic attack (2.1% vs. 1.3%; p = 0.049), and bleeding or transfusion (6.1% vs. 3.5%; p = 0.002) compared with high-volume hospitals. No differences were noted for other components of MAE and index length of stay. On multivariate analysis, higher procedural volume was associated with lower rates of in-hospital MAE, with an adjusted odds ratio for medium versus low volume of 0.69 (95% confidence interval: 0.46 to 1.04; p = 0.08) and for high versus low volume of 0.55 (95% confidence interval: 0.37 to 0.82; p = 0.003).
Conclusions:
Higher hospital procedural volume is associated with better outcomes for LAAO procedures. Further studies are needed to determine if this relationship persists for long-term outcomes.
