Volume-outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK)

Zahn, Ralf; Gottwik, Martin; Hochadel, Matthias; Senges, Jochen; Zeymer, Uwe; Vogt, A.; Meinertz, Thomas; Dietz, Rainer; Hauptmann, Karl E.; Grube, Eberhard; Kerber, Sebastian; Sechtem, Udo

doi:10.1136/hrt.2007.118737

Cited by 46 publications

(36 citation statements)

References 30 publications

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“…Barker et al compiled national inpatient data that suggest that among patients undergoing transsphenoidal pituitary adenoma resection, those who were admitted to high-volume centers had lower mortality rates, better hospital discharge disposition, and fewer complications (15). This direct association between provider volume and improved patient outcome is consistent with the reports from multiple surgical subspecialties, such as surgical oncology (20,24,25), cardiovascular surgery (19,21,(26)(27)(28)(29)(30), abdominal surgery (31-37), urology (38), and ophthalmology (39). Recent reports in general surgery have indicated that referral to high-volume hospitals is dependent on racial and socioeconomic factors, with non-whites having a reduced likelihood of being admitted to high-volume institutions (40).…”

Section: Introductionsupporting

confidence: 77%

Predictors of access to pituitary tumor resection in the United States, 1988–2005

Mukherjee¹,

Zaidi²,

Kosztowski³

et al. 2009

European Journal of Endocrinology

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Objective: Surgery remains a common form of treatment for sellar and parasellar tumors involving the pituitary gland and adjacent structures. Studies have suggested that pituitary surgery procedures performed at high-volume centers are associated with less adverse outcomes, yet it remains unclear which types of patients are more likely to be admitted to such centers. We set out to determine which factors most influenced admission to these high-volume centers. Methods: A retrospective analysis of the National Inpatient Sample over an 18-year period was linked to socioeconomic and environmental data contained within the Area Resource File. Only patients undergoing transsphenoidal surgery in the United States, O18-years-old were included. The primary outcome was admission to a high-volume (O25 pituitary surgeries/year) hospital. Results: Overall, patients' odds of admission to a high-volume center increased over an 18-year time period. However, African-Americans (odds ratio, ORZ0.46), Hispanics (ORZ0.28), and Asians (ORZ0.49) experienced declining odds of admission over time. Patients from high-income brackets (ORZ1.53) and from areas with higher neurosurgeon density (ORZ1.61) were more likely to be admitted to high-volume centers. Conversely, patients coming from counties with higher poverty (ORZ0.92) were less likely to be admitted to high-volume centers. Conclusion: Racial and socioeconomic factors play a significant role in the admission of patients to highvolume pituitary surgery centers. This study demonstrates potential key policy areas for meaningful intervention to help ease disparities in access to quality care for surgical pituitary disease.

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Section: Introductionsupporting

confidence: 77%

Predictors of access to pituitary tumor resection in the United States, 1988–2005

Mukherjee¹,

Zaidi²,

Kosztowski³

et al. 2009

European Journal of Endocrinology

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“…The relationship of these outcomes and operator or institutional volume has not been shown earlier. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]35 Our study demonstrates a statistically significant inverse association between operator volume and outcome (in-hospital mortality and peri-procedural complications) in the current practice. Our results are in agreement with results from previous studies done both in the percutaneous transluminal coronary angioplasty and the stent era.…”

mentioning

confidence: 60%

“…Our results are in agreement with results from previous studies done both in the percutaneous transluminal coronary angioplasty and the stent era. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]35,36 Previous studies have been limited by the number of centers, 12,20 state-based registry data, 8,14,15,18 inclusion of only limited cohorts, 16 lower sample size, 8,9,[11][12][13][14][15][16][17][18]20 foreign studies, 11,19,21 and most importantly they lack data from recent era. 6,7,9,16 Previous studies, which have shown a decrease in mortality with increasing operator volume, have failed to reach statistical significance because of low sample size, large confidence interval, or low procedure related mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Some of these data were derived from state registries and are dated. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The purpose of this study was to determine the association of annual PCI operator and institutional volume with in-hospital mortality, peri-procedural complications, length of hospital stay, and cost of hospitalization using the nation's largest available all-payer insurance inpatient database in a recent era (2005)(2006)(2007)(2008)(2009)) during which procedural techniques and practices have remained relatively stable.…”

mentioning

confidence: 99%

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Impact of Annual Operator and Institutional Volume on Percutaneous Coronary Intervention Outcomes

et al. 2014

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1 and the 2011 percutaneous coronary intervention (PCI) guidelines recommend (Class IC) that PCIs should be performed by operators with an annual volume (>75 procedures) at high-volume centers (>400 procedures) with on-site cardiac surgery. 2 The last decade has observed a decline in number of PCIs performed, and many interventional cardiologists have experienced a drop in procedural volume. 3,4 As a result, the Background-The relationship between operator or institutional volume and outcomes among patients undergoing percutaneous coronary interventions (PCI) is unclear. Methods and Results-Cross-sectional study based on the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample between 2005 to 2009. Subjects were identified by International Classification of Diseases, 9 th Revision, Clinical Modification procedure code, 36.06 and 36.07. Annual operator and institutional volumes were calculated using unique identification numbers and then divided into quartiles. Three-level hierarchical multivariate mixed models were created. The primary outcome was in-hospital mortality; secondary outcome was a composite of in-hospital mortality and peri-procedural complications. A total of 457 498 PCIs were identified representing a total of 2 243 209 PCIs performed in the United States during the study period. In-hospital, all-cause mortality was 1.08%, and the overall complication rate was 7.10%. ]. Spline analysis also showed significant operator and institutional volume outcome relationship. Similarly operators in the higher quartiles witnessed a significant reduction in length of hospital stay and cost of hospitalization (P<0.001). Conclusions-Overall in-hospital mortality after PCI was low. An increase in operator and institutional volume of PCI was found to be associated with a decrease in adverse outcomes, length of hospital stay, and cost of hospitalization. 5 These recommendations, however, are based on expert opinion derived from the interpretation of data from multiple sources with inherent limitations. Some of these data were derived from state registries and are dated. 5-24The purpose of this study was to determine the association of annual PCI operator and institutional volume with in-hospital mortality, peri-procedural complications, length of hospital stay, and cost of hospitalization using the nation's largest available all-payer insurance inpatient database in a recent era (2005)(2006)(2007)(2008)(2009)) during which procedural techniques and practices have remained relatively stable. Methods Data SourceWe analyzed 5-year data from the 2005 to 2009 from National Inpatient Sample (NIS) database. The NIS is a subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality (AHRQ). The NIS is the largest publicly available all-payer inpatient care database in the United States; including data on approximately 7 to 8 million discharges per year, it is stratified to sample approximately 20% sample of US community (nonfederal, short-term, general, a...

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“…In our study, crude 30-day mortality rate was 1.1% (Table 2). Zahn et al (24) reported an in-hospital mortality of 1.85% in hospitals belonging to the lowest PCI volume quartile and 1.21% in the highest quartile. But technological improvement of PCI, PCI instruments and new pharmacologic therapies in recent years it might have reduced mortality.…”

Section: Discussionmentioning

confidence: 99%

Relationship between hospital volume and risk-adjusted mortality rate following percutaneous coronary intervention in Korea, 2003 to 2004

Kim¹,

Her²

2013

Anadolu Kardiyol Derg

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Objective: There have been a large number of studies that have investigated the relationship between outcomes and provider volume for a wide variety of medical conditions and surgical conditions. The objective of this study was to explore the relation between hospital volume and riskadjusted mortality following percutaneous coronary intervention between 2003 and 2004 in Korea. Methods: This is a retrospective analysis of database in National Health Insurance Review & Assessment Service and Korean National Statistical Office. The study data set confined to the ICD-10 diagnosis and procedure codes that were recorded in the National Health Insurance Review Agency. Risk modeling was performed through logistic regression and validated with cross-validation. The statistical performance of the developed model was evaluated using c-statistics, R 2 , and Hosmer-Lemeshow statistic. Crude and risk-adjusted 30-day mortality was evaluated among patients who underwent Percutaneous Coronary Intervention (PCI) between 2003 and 2004 at low (less 200 cases/year), medium (200~399 cases/year), and high (400 cases or more/year) PCI volume hospitals. Results: The final risk-adjustment model consisted of ten risk factors for 30-day mortality. These factors were found to have statistically significant effects on patient mortality. The c-statistic and Hosmer-Lemeshow χ 2 goodness-of-fit test and the model's performance were good [R 2 =0.147, c-statistic 0.823, 4.1037 (p=0.8476)]. A total number of 60 low-volume hospitals (9.071 patients) and 27 medium-volume hospitals (15.623 patients) and 15 high-volume hospitals (19.669 patients) were included. Crude 30-day mortality rate was 1.4%, 1.1%, and 1.0% (p=0.0106) in each volume hospitals. But risk-adjusted mortality rate was not significantly different among three groups (1.3%, 1.0%, and 1.1% in each volume hospitals). Conclusion: Although we found a significant different crude 30-day mortality rates according to hospital PCI volume, but did not find a relationship between hospital volume and 30-day risk-adjusted mortality rates following PCI in Korea. (Anadolu Kardiyol Derg 2013; 13: 237-42)

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Volume-outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK)

Abstract: This analysis of contemporary PCI in clinical practice shows a small but significant volume-outcome relation for in-hospital mortality. However, this relation was only apparent in high-risk subgroups, such as patients presenting with acute myocardial infarction.

Cited by 46 publications

References 30 publications

Predictors of access to pituitary tumor resection in the United States, 1988–2005

Predictors of access to pituitary tumor resection in the United States, 1988–2005

Impact of Annual Operator and Institutional Volume on Percutaneous Coronary Intervention Outcomes

Relationship between hospital volume and risk-adjusted mortality rate following percutaneous coronary intervention in Korea, 2003 to 2004

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