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Robotic Ablation of Atrial Fibrillation
Published on: May 29, 2015
Impact of Hospital VT Ablation Volume on Postprocedural Complications: Argument for Selective Referral to High-Volume
Agam Bansal1, Anirudh Nandan1, Jakub Sroubek1
1Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Insights
High-volume hospitals performing ventricular tachycardia (VT) ablation have better patient outcomes. Referring patients to these centers can significantly decrease complications and mortality from VT ablation procedures.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Hospital procedure volume is linked to outcomes in cardiovascular interventions.
- The effect of hospital volume on ventricular tachycardia (VT) ablation complications and the benefit of selective referral remain understudied.
Purpose of the Study:
- To evaluate the association between hospital procedure volume for VT catheter ablation and postprocedural morbidity and mortality.
Main Methods:
- The National Inpatient Sample (NIS) database was used to analyze VT ablation admissions in the US during 2019.
- Hospitals were categorized into low-volume (LVH, ≤15 ablations/year), medium-volume (16-49 ablations/year), and high-volume (HVH, ≥50 ablations/year) tertiles.
- In-hospital mortality and postprocedural complications were collected and analyzed.
Main Results:
- Patients treated at HVH had higher rates of comorbidities like heart failure and kidney disease.
- After adjusting for confounders, HVH demonstrated lower in-hospital mortality (aOR=0.80), cardiac tamponade (aOR=0.58), and need for blood transfusion (aOR=0.41) compared to LVH.
- An estimated one death, cardiac tamponade, or major bleeding event could be prevented for every 17 patients transferred from LVH to HVH.
Conclusions:
- Despite treating sicker patients, HVH achieved lower in-hospital mortality and procedure-related morbidity for VT ablation compared to LVH.
- Selective referral of VT patients to HVH holds significant potential for national reduction in in-hospital complications.
Background:
Existing studies have shown a relationship between hospital case volume and outcomes of various cardiovascular procedures. The impact of hospital procedure volume on complications of catheter ablation of ventricular tachycardia (VT) and the potential benefit of selective referral to high-volume centers have not been previously evaluated.
Objectives:
This study sought to assess the associations between hospital procedure volume of VT catheter ablation and postprocedural morbidity and mortality.
Methods:
The NIS (National Inpatient Sample) database was queried for hospital admissions for VT ablation in the United States during the year 2019. Hospitals were divided into tertiles of VT ablation volume (high-volume hospitals [HVH] ≥50 ablations per year, medium-volume hospitals performed 16-49 ablations, and low-volume hospitals [LVH] ≤ 15 ablations). Data on adverse events including in-hospital mortality and postprocedural complications were collected.
Results:
Patients in HVH were more likely to have comorbidities including heart failure (74.3% vs 64.7%; P = 0.02) and kidney disease (25.3% vs 21.7%; P = 0.044) than LVH. After controlling for baseline confounders and with LVH as reference, HVH had lower in-hospital mortality (adjusted OR [aOR]: 0.80; 95% CI: 0.71-0.91; P = 0.04), cardiac tamponade (aOR: 0.58; 95% CI: 0.32-0.78; P = 0.01), and need for blood transfusion (aOR: 0.41; 95% CI: 0.21-0.68; P = 0.008). It can be estimated that for every 17 patients shifted from LVH to HVH, 1 death, cardiac tamponade, or major bleeding event could be prevented.
Conclusions:
Patients undergoing VT ablation at HVH were sicker on average, yet had lower in-hospital mortality and procedure-related morbidity compared to LVH. Selective VT patient referral to HVH has the potential to substantially reduce in-hospital complications following VT ablation nationally.
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