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Does low individual operator coronary interventional procedural volume correlate with worse institutional procedural
L W Klein1, G L Schaer, J E Calvin
1Rush Heart Institute, Chicago, IL, USA. lklein@rps/mc.edu
Insights
Even with operator volumes below proposed certification levels, this study found excellent in-hospital outcomes for coronary interventions. Lower complication rates were observed compared to national registries, highlighting institutional success.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Services Research
Background:
- Future certification may require 75 coronary interventions per operator annually.
- Limited data exist on the relationship between individual operator volume and procedural outcomes.
- Assessing operator volume impact is crucial for quality assurance in interventional cardiology.
Purpose of the Study:
- To evaluate the association between individual operator coronary interventional volume and complication incidence.
- To analyze in-hospital outcomes at a single urban academic center over a three-year period.
- To compare institutional outcomes with established national registries.
Main Methods:
- Prospective data collection of 1,389 coronary interventions performed or supervised by nine operators from January 1993 to December 1995.
- Analysis of patient demographics, clinical indications, lesion complexity (types A, B, C), and procedural details.
- Comparison of in-hospital major complication rates with four previously published registries.
Main Results:
- Average yearly operator volume was 51 cases, with a mean of 590 total interventions per operator.
- The overall in-hospital major complication rate was 1.4%, significantly lower than reported in multiple national registries.
- Outcomes were comparable or superior to standard registries, despite operator volumes below proposed credentialing thresholds.
Conclusions:
- Excellent institutional outcomes were achieved in a complex patient population.
- Individual operator volumes below proposed credentialing levels did not negatively impact overall patient safety.
- This study suggests that high-quality patient care can be maintained even with moderate operator volumes.
Objectives:
To assess the relation between individual operator coronary interventional volume and incidence of complications, the in-hospital outcome at a single, moderate volume urban academic center was prospectively collected over a 3-year period.
Background:
A minimum of 75 coronary interventions/operator per year may be required in the future to obtain formal certification. However, few data exist regarding individual operator volumes and procedural outcome.
Methods:
Between January 1993 and December 1995, 1,389 consecutive procedures were performed or supervised by nine geographic full-time operators: 171 (12.3%) utilized various devices, and 350 (25.2%) involved multivessel coronary intervention. Left ventricular ejection fraction was 59 +/- 15% (mean +/- SD), and there were 1.7 +/- 0.7 vessels diseased (with > or = 70% stenosis). Clinical indications included stable angina in 22.5% of cases, unstable angina in 31.9%, acute myocardial infarction (MI) in 2.9%, post MI in 20.6%, shock or acute heart failure in 3.0% and restenosis in 19.1%. In the last consecutive 857 lesions in 655 cases, 20.7% type A, 55.5% type B and 23.8% type C lesions were categorized before coronary intervention.
Results:
Average yearly operator volume ranged from 26 to 83 cases (mean 51 +/- 26). Each operator has performed a total of 590 +/- 268 coronary interventions, with 10.0 +/- 4.3 years of coronary interventional experience. The mean angioplasty volume rating for the nine operators was 180 +/- 37 (> 170 considered adequate). The in-hospital major complication rate was 1.4% (95% confidence interval 0.7% to 1.893%) for all coronary interventions, including death in 3 patients, bypass surgery in 13, arrhythmia in 3 and Q wave MI in 2. To ascertain how these outcomes compared with standard measures of coronary interventional outcome, four previously published registries were reanalyzed in a similar manner. The rate of complications in the present study was found to be significantly lower than that of the 1992-1993 Society for Cardiac Angiography and Intervention registry (1.9%, n = 19,594, p < 0.05 [excludes ventricular arrhythmias]), the 1994 American College of Cardiology database (3.9%, n = 38,963, p = 0.001), the Mid-America Heart Institute outcome in 1988 (2.3%, n = 5,413, p = 0.02) and the 1985-1986 National Heart, Lung, and Blood Institute Registry (7.2%, n = 1,801, p = 0.001). Odds ratios and 95% confidence intervals showed the outcome in the current study to be at least comparable to the standard registries.
Conclusions:
Despite individual operator volumes below those currently being considered for credentialing, the overall institutional outcome was excellent in a diverse and complex patient population.