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Association of Hospital Procedural Volume With Outcomes of Left Ventricular Assist Device Placement
Shazib Sagheer1, Abdul Mannan Khan Minhas2, Syeda Humna Zaidi3
1Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, NM; Division of Interventional Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA.
Insights
High-volume centers significantly reduce inpatient mortality for durable left ventricular assist device (LVAD) implantations. Medium-volume centers show a trend toward lower mortality, suggesting hospital volume impacts patient outcomes.
Area of Science:
- Cardiology
- Medical Devices
- Health Services Research
Background:
- Durable left ventricular assist devices (LVADs) are increasingly used.
- Evidence is lacking on whether LVAD implantation volume affects patient outcomes.
Purpose of the Study:
- To investigate the relationship between hospital volume and clinical outcomes after LVAD implantation.
- To compare outcomes at low-, medium-, and high-volume centers.
Main Methods:
- Analysis of the Nationwide Readmission Database for 2019 LVAD implantations.
- Comparison of baseline comorbidities and hospital characteristics across volume groups.
- Multilevel mixed-effect regression models to assess volume-outcome relationships.
Main Results:
- High-volume centers had significantly lower inpatient mortality (9.04%) compared to low-volume centers (18.49%).
- Medium-volume centers showed a non-significant trend toward lower mortality.
- No significant differences were observed in major adverse events, complications, length of stay, cost, or readmission rates.
Conclusions:
- Higher hospital volume for LVAD implantation is associated with reduced inpatient mortality.
- A trend towards improved outcomes in medium-volume centers warrants further investigation.
Background:
With the advancement in device technology, the use of durable left ventricular assist devices (LVADs) has increased significantly in recent years. However, there is a dearth of evidence to conclude whether patients who undergo LVAD implantation at high-volume centers have better clinical outcomes than those receiving care at low- or medium-volume centers.
Methods:
We analyzed the hospitalizations using the Nationwide Readmission Database for the year 2019 for new LVAD implantation. Baseline comorbidities and hospital characteristics were compared among low- (1-5 procedures/year), medium- (6-16 procedures/year) and high-volume (17-72 procedures/year) hospitals. The volume/outcome relationship was analyzed using the annualized hospital volume as a categorical variable (tertiles) as well as a continuous variable. Multilevel mixed-effect logistic regression and negative binomial regression models were used to determine the association of hospital volume and outcomes, with tertile 1 (low-volume hospitals) as the reference category.
Results:
A total of 1533 new LVAD procedures were included in the analysis. The inpatient mortality rate was lower in the high-volume centers compared with the low-volume centers (9.04% vs 18.49%, aOR 0.41, CI0.21-0.80; P = 0.009). There was a trend toward lower mortality rates in medium-volume centers compared with low-volume centers; however, it did not reach statistical significance (13.27% vs 18.49%, aOR 0.57, CI0.27-1.23; P = 0.153). Similar results were seen for major adverse events (composite of stroke/transient ischemic attack and in-hospital mortality). There was no significant difference in bleeding/transfusion, acute kidney injury, vascular complications, pericardial effusion/hemopericardium/tamponade, length of stay, cost, or 30-day readmission rates between medium- and high-volume centers compared to low-volume centers.
Conclusion:
Our findings indicate lower inpatient mortality rates in high-volume LVAD implantation centers and a trend toward lower mortality rates in medium-volume LVAD implantation centers compared to lower-volume centers.
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