Complications after complex device implantation: how important is implanter seniority?

Area of Science:

• Cardiology
• Medical Device Technology
• Health Services Research

Background:

• Procedure complication risks can be linked to operator and institutional factors.
• Investigating the impact of consultant experience and volume on reintervention after complex device implantation is crucial.

Purpose of the Study:

• To assess if supervising consultant seniority, operative volume, and hospital volume influence reintervention risk following complex device implantation.

Main Methods:

• A nationwide population-based study analyzed data from England (April 2014-March 2019).
• Included first transvenous implantable cardioverter defibrillator or cardiac resynchronisation therapy (CRT) implants.
• Used multilevel logistic regression to evaluate associations between 1-year reintervention and operator/hospital volume and seniority.

Main Results:

• No association found between increasing supervising consultant volume and reintervention risk.
• A borderline significant association between operator volume and reintervention was observed for CRT-pacemakers/defibrillators in the highest volume quartile.
• A U-shaped relationship was identified between reintervention risk and supervising consultant seniority, with mid-seniority operators showing lower risk.

Conclusions:

• Operator seniority exhibits a U-shaped association with reintervention risk for complex devices.
• Newly qualified consultants may benefit from mentorship, and all operators should engage in continuous outcome evaluation and sharing.