Effect of Hospital Volume on Outcomes of Transcatheter Aortic Valve Implantation

Apurva O Badheka; Nileshkumar J Patel; Sidakpal S Panaich; Samir V Patel; Sunny Jhamnani; Vikas Singh; Sadip Pant; Nish Patel; Nilay Patel; Shilpkumar Arora; Badal Thakkar; Sohilkumar Manvar; Abhijeet Dhoble; Achint Patel; Chirag Savani; Jay Patel; Ankit Chothani; Ghanshyambhai T Savani; Abhishek Deshmukh; Cindy L Grines; Jeptha Curtis; Abeel A Mangi; Michael Cleman; John K Forrest

doi:10.1016/j.amjcard.2015.05.019

Back

Effect of Hospital Volume on Outcomes of Transcatheter Aortic Valve Implantation

Journal article

Peer reviewed

Effect of Hospital Volume on Outcomes of Transcatheter Aortic Valve Implantation

Apurva O Badheka, Nileshkumar J Patel, Sidakpal S Panaich, Samir V Patel, Sunny Jhamnani, Vikas Singh, Sadip Pant, Nish Patel, Nilay Patel, Shilpkumar Arora, …

The American journal of cardiology, Vol.116(4), pp.587-594

08/15/2015

DOI: 10.1016/j.amjcard.2015.05.019

PMID: 26092276

View Online

Abstract

Transcatheter aortic valve implantation (TAVI) is associated with a significant learning curve. There is paucity of data regarding the effect of hospital volume on outcomes after TAVI. This is a cross-sectional study based on Healthcare Cost and Utilization Project's Nationwide Inpatient Sample database of 2012. Subjects were identified by International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes, 35.05 (Trans-femoral/Trans-aortic Replacement of Aortic Valve) and 35.06 (Trans-apical Replacement of Aortic Valve). Annual hospital TAVI volumes were calculated using unique identification numbers and then divided into quartiles. Multivariate logistic regression models were created. The primary outcome was inhospital mortality; secondary outcome was a composite of inhospital mortality and periprocedural complications. Length of stay (LOS) and cost of hospitalization were assessed. The study included 1,481 TAVIs (weighted n = 7,405). Overall inhospital mortality rate was 5.1%, postprocedural complication rate was 43.4%, median LOS was 6 days, and median cost of hospitalization was $51,975. Inhospital mortality rates decreased with increasing hospital TAVI volume with a rate of 6.4% for lowest volume hospitals (first quartile), 5.9% (second quartile), 5.2% (third quartile), and 2.8% for the highest volume TAVI hospitals (fourth quartile). Complication rates were significantly higher in hospitals with the lowest volume quartile (48.5%) compared to hospitals in the second (44.2%), third (39.7%), and fourth (41.5%) quartiles (p <0.001). Increasing hospital volume was independently predictive of shorter LOS and lower hospitalization costs. In conclusion, higher annual hospital volumes are significantly predictive of reduced postprocedural mortality, complications, shorter LOS, and lower hospitalization costs after TAVI.

Aortic Valve Stenosis - economics

Transcatheter Aortic Valve Replacement - economics

Cross-Sectional Studies

Hospital Mortality

Humans

Hospitalization - statistics & numerical data

Logistic Models

Male

Treatment Outcome

Aortic Valve Stenosis - mortality

Health Care Costs

Aged, 80 and over

Female

Aortic Valve Stenosis - surgery

Transcatheter Aortic Valve Replacement - statistics & numerical data

Databases, Factual

Hospitalization - economics

Transcatheter Aortic Valve Replacement - adverse effects

Details

Title: Subtitle: Effect of Hospital Volume on Outcomes of Transcatheter Aortic Valve Implantation
Creators: Apurva O Badheka - Cardiology Department, Yale School of Medicine, New Haven, Connecticut
Nileshkumar J Patel - Internal Medicine Department, Staten Island University Hospital, Staten Island, New York
Sidakpal S Panaich - Cardiology Department, Detroit Medical Center, Detroit, Michigan
Samir V Patel - Internal Medicine Department, Western Reserve Health System, Youngstown, Ohio
Sunny Jhamnani - Cardiology Department, Yale School of Medicine, New Haven, Connecticut
Vikas Singh - Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida
Sadip Pant - Internal Medicine Department, University of Louisville, Louisville, Kentucky
Nish Patel - Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida
Nilay Patel - Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New Jersey
Shilpkumar Arora - Internal Medicine Department, Mount Sinai St Luke's Roosevelt, New York, New York
Badal Thakkar - Internal Medicine Department, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
Sohilkumar Manvar - Cardiology Department, Detroit Medical Center, Detroit, Michigan
Abhijeet Dhoble - Internal Medicine Department, UT Houston Health Science Center, Houston, Texas
Achint Patel - Internal Medicine Department, Icahn School of Medicine at Mount Sinai, New York, New York
Chirag Savani - Internal Medicine Department, New York Medical College, Valhalla, New York
Jay Patel - Cardiology Department, Detroit Medical Center, Detroit, Michigan
Ankit Chothani - Internal Medicine Department, Med Star Washington Hospital Center, Washington, D.C
Ghanshyambhai T Savani - Internal Medicine Department, Prince George's Hospital Center, Cheverly, Maryland
Abhishek Deshmukh - Cardiology Department, Mayo Clinic, Rochester, Minnesota
Cindy L Grines - Cardiology Department, Detroit Medical Center, Detroit, Michigan
Jeptha Curtis - Cardiology Department, Yale School of Medicine, New Haven, Connecticut
Abeel A Mangi - Cardiology Department, Yale School of Medicine, New Haven, Connecticut
Michael Cleman - Cardiology Department, Yale School of Medicine, New Haven, Connecticut
John K Forrest - Cardiology Department, Yale School of Medicine, New Haven, Connecticut. Electronic address: john.k.forrest@yale.edu
Resource Type: Journal article
Publication Details: The American journal of cardiology, Vol.116(4), pp.587-594
DOI: 10.1016/j.amjcard.2015.05.019
PMID: 26092276
ISSN: 0002-9149
eISSN: 1879-1913
Language: English
Date published: 08/15/2015
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984094216002771

Metrics

11 Record Views

72 Times Cited - Web of Science

See more details