Association of Hospital Procedural Volume With Outcomes of Percutaneous Left Atrial Appendage Occlusion
The aim of this study was to examine the association between percutaneous left atrial appendage occlusion (LAAO) procedural volume and in-hospital outcomes. Several studies have demonstrated an inverse volume-outcome relationship for patients undergoing invasive cardiac procedures. Whether a similar...
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| Veröffentlicht in: | JACC. Cardiovascular interventions 2021-03, Vol.14 (5), p.554-561 |
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| creator | Nazir, Salik Ahuja, Keerat Rai Kolte, Dhaval Isogai, Toshiaki Michihata, Nobuaki Saad, Anas M. Ramanathan, P. Kasi Krishnaswamy, Amar Wazni, Oussama M. Saliba, Walid I. Gupta, Rajesh Kapadia, Samir R. |
| description | The aim of this study was to examine the association between percutaneous left atrial appendage occlusion (LAAO) procedural volume and in-hospital outcomes.
Several studies have demonstrated an inverse volume-outcome relationship for patients undergoing invasive cardiac procedures. Whether a similar association exists for percutaneous LAAO remains unknown.
Patients undergoing LAAO in 2017 were identified in the Nationwide Readmissions Database. Hospitals were categorized into 3 groups on the basis of tertiles of annual procedural volume: low (5 to 15 cases/year), medium (17 to 31 cases/year), and high (32 to 211 cases/year). Multivariate hierarchical logistic regression and restricted cubic spline analyses were performed to examine the association of hospital LAAO volume and outcomes. The primary outcome was in-hospital major adverse events (MAE), defined as a composite of mortality, stroke or transient ischemic attack, bleeding or transfusion, vascular complications, myocardial infarction, systemic embolization, and pericardial effusion or tamponade requiring pericardiocentesis or surgery.
This study included 5,949 LAAO procedures performed across 196 hospitals with a median annual procedural volume of 41 (interquartile range: 25 to 67). Low-volume hospitals had higher rates of in-hospital MAE (9.5% vs. 5.6%; p |
| doi_str_mv | 10.1016/j.jcin.2020.11.029 |
| format | Article |
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Several studies have demonstrated an inverse volume-outcome relationship for patients undergoing invasive cardiac procedures. Whether a similar association exists for percutaneous LAAO remains unknown.
Patients undergoing LAAO in 2017 were identified in the Nationwide Readmissions Database. Hospitals were categorized into 3 groups on the basis of tertiles of annual procedural volume: low (5 to 15 cases/year), medium (17 to 31 cases/year), and high (32 to 211 cases/year). Multivariate hierarchical logistic regression and restricted cubic spline analyses were performed to examine the association of hospital LAAO volume and outcomes. The primary outcome was in-hospital major adverse events (MAE), defined as a composite of mortality, stroke or transient ischemic attack, bleeding or transfusion, vascular complications, myocardial infarction, systemic embolization, and pericardial effusion or tamponade requiring pericardiocentesis or surgery.
This study included 5,949 LAAO procedures performed across 196 hospitals with a median annual procedural volume of 41 (interquartile range: 25 to 67). Low-volume hospitals had higher rates of in-hospital MAE (9.5% vs. 5.6%; p < 0.001), stroke or transient ischemic attack (2.1% vs. 1.3%; p = 0.049), and bleeding or transfusion (6.1% vs. 3.5%; p = 0.002) compared with high-volume hospitals. No differences were noted for other components of MAE and index length of stay. On multivariate analysis, higher procedural volume was associated with lower rates of in-hospital MAE, with an adjusted odds ratio for medium versus low volume of 0.69 (95% confidence interval: 0.46 to 1.04; p = 0.08) and for high versus low volume of 0.55 (95% confidence interval: 0.37 to 0.82; p = 0.003).
Higher hospital procedural volume is associated with better outcomes for LAAO procedures. Further studies are needed to determine if this relationship persists for long-term outcomes.
[Display omitted]</description><identifier>ISSN: 1936-8798</identifier><identifier>EISSN: 1876-7605</identifier><identifier>DOI: 10.1016/j.jcin.2020.11.029</identifier><identifier>PMID: 33663783</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>hospital volume ; left atrial appendage occlusion ; outcomes ; Watchman</subject><ispartof>JACC. Cardiovascular interventions, 2021-03, Vol.14 (5), p.554-561</ispartof><rights>2021 American College of Cardiology Foundation</rights><rights>Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-1dc3c8dcea9bd6c29a993f9e778f69fe4dae950a9d4608ddfd92fa59b6c36d2b3</citedby><cites>FETCH-LOGICAL-c400t-1dc3c8dcea9bd6c29a993f9e778f69fe4dae950a9d4608ddfd92fa59b6c36d2b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1936879820323086$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33663783$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nazir, Salik</creatorcontrib><creatorcontrib>Ahuja, Keerat Rai</creatorcontrib><creatorcontrib>Kolte, Dhaval</creatorcontrib><creatorcontrib>Isogai, Toshiaki</creatorcontrib><creatorcontrib>Michihata, Nobuaki</creatorcontrib><creatorcontrib>Saad, Anas M.</creatorcontrib><creatorcontrib>Ramanathan, P. Kasi</creatorcontrib><creatorcontrib>Krishnaswamy, Amar</creatorcontrib><creatorcontrib>Wazni, Oussama M.</creatorcontrib><creatorcontrib>Saliba, Walid I.</creatorcontrib><creatorcontrib>Gupta, Rajesh</creatorcontrib><creatorcontrib>Kapadia, Samir R.</creatorcontrib><title>Association of Hospital Procedural Volume With Outcomes of Percutaneous Left Atrial Appendage Occlusion</title><title>JACC. Cardiovascular interventions</title><addtitle>JACC Cardiovasc Interv</addtitle><description>The aim of this study was to examine the association between percutaneous left atrial appendage occlusion (LAAO) procedural volume and in-hospital outcomes.
Several studies have demonstrated an inverse volume-outcome relationship for patients undergoing invasive cardiac procedures. Whether a similar association exists for percutaneous LAAO remains unknown.
Patients undergoing LAAO in 2017 were identified in the Nationwide Readmissions Database. Hospitals were categorized into 3 groups on the basis of tertiles of annual procedural volume: low (5 to 15 cases/year), medium (17 to 31 cases/year), and high (32 to 211 cases/year). Multivariate hierarchical logistic regression and restricted cubic spline analyses were performed to examine the association of hospital LAAO volume and outcomes. The primary outcome was in-hospital major adverse events (MAE), defined as a composite of mortality, stroke or transient ischemic attack, bleeding or transfusion, vascular complications, myocardial infarction, systemic embolization, and pericardial effusion or tamponade requiring pericardiocentesis or surgery.
This study included 5,949 LAAO procedures performed across 196 hospitals with a median annual procedural volume of 41 (interquartile range: 25 to 67). Low-volume hospitals had higher rates of in-hospital MAE (9.5% vs. 5.6%; p < 0.001), stroke or transient ischemic attack (2.1% vs. 1.3%; p = 0.049), and bleeding or transfusion (6.1% vs. 3.5%; p = 0.002) compared with high-volume hospitals. No differences were noted for other components of MAE and index length of stay. On multivariate analysis, higher procedural volume was associated with lower rates of in-hospital MAE, with an adjusted odds ratio for medium versus low volume of 0.69 (95% confidence interval: 0.46 to 1.04; p = 0.08) and for high versus low volume of 0.55 (95% confidence interval: 0.37 to 0.82; p = 0.003).
Higher hospital procedural volume is associated with better outcomes for LAAO procedures. Further studies are needed to determine if this relationship persists for long-term outcomes.
[Display omitted]</description><subject>hospital volume</subject><subject>left atrial appendage occlusion</subject><subject>outcomes</subject><subject>Watchman</subject><issn>1936-8798</issn><issn>1876-7605</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kE2LFDEQhoMo7rr6BzxIH730mI-edBd4GRZ1hYHZgx_HkKlU1gzdnTZJC_57M8zq0VOK8LwvVQ9jrwXfCC70u9PmhGHeSC7rh9hwCU_YtRh63faab5_WGZRuhx6GK_Yi5xPnmkMvn7MrpbRW_aCu2cMu54jBlhDnJvrmLuYlFDs29ykiuTXV8Vsc14ma76H8aA5rwThRPrP3lHAtdqa45mZPvjS7kkIN7JaFZmcfqDkgjmuu3S_ZM2_HTK8e3xv29eOHL7d37f7w6fPtbt9ix3lphUOFg0OycHQaJVgA5YH6fvAaPHXOEmy5BddpPjjnHUhvt3DUqLSTR3XD3l56lxR_rpSLmUJGGsfLmkZ2MHQ9QCcrKi8opphzIm-WFCabfhvBzVmwOZmzYHMWbIQwVXANvXnsX48TuX-Rv0Yr8P4CUL3yV6BkMgaaq8uQCItxMfyv_w9qu47Y</recordid><startdate>20210308</startdate><enddate>20210308</enddate><creator>Nazir, Salik</creator><creator>Ahuja, Keerat Rai</creator><creator>Kolte, Dhaval</creator><creator>Isogai, Toshiaki</creator><creator>Michihata, Nobuaki</creator><creator>Saad, Anas M.</creator><creator>Ramanathan, P. Kasi</creator><creator>Krishnaswamy, Amar</creator><creator>Wazni, Oussama M.</creator><creator>Saliba, Walid I.</creator><creator>Gupta, Rajesh</creator><creator>Kapadia, Samir R.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20210308</creationdate><title>Association of Hospital Procedural Volume With Outcomes of Percutaneous Left Atrial Appendage Occlusion</title><author>Nazir, Salik ; Ahuja, Keerat Rai ; Kolte, Dhaval ; Isogai, Toshiaki ; Michihata, Nobuaki ; Saad, Anas M. ; Ramanathan, P. Kasi ; Krishnaswamy, Amar ; Wazni, Oussama M. ; Saliba, Walid I. ; Gupta, Rajesh ; Kapadia, Samir R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-1dc3c8dcea9bd6c29a993f9e778f69fe4dae950a9d4608ddfd92fa59b6c36d2b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>hospital volume</topic><topic>left atrial appendage occlusion</topic><topic>outcomes</topic><topic>Watchman</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nazir, Salik</creatorcontrib><creatorcontrib>Ahuja, Keerat Rai</creatorcontrib><creatorcontrib>Kolte, Dhaval</creatorcontrib><creatorcontrib>Isogai, Toshiaki</creatorcontrib><creatorcontrib>Michihata, Nobuaki</creatorcontrib><creatorcontrib>Saad, Anas M.</creatorcontrib><creatorcontrib>Ramanathan, P. Kasi</creatorcontrib><creatorcontrib>Krishnaswamy, Amar</creatorcontrib><creatorcontrib>Wazni, Oussama M.</creatorcontrib><creatorcontrib>Saliba, Walid I.</creatorcontrib><creatorcontrib>Gupta, Rajesh</creatorcontrib><creatorcontrib>Kapadia, Samir R.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nazir, Salik</au><au>Ahuja, Keerat Rai</au><au>Kolte, Dhaval</au><au>Isogai, Toshiaki</au><au>Michihata, Nobuaki</au><au>Saad, Anas M.</au><au>Ramanathan, P. Kasi</au><au>Krishnaswamy, Amar</au><au>Wazni, Oussama M.</au><au>Saliba, Walid I.</au><au>Gupta, Rajesh</au><au>Kapadia, Samir R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of Hospital Procedural Volume With Outcomes of Percutaneous Left Atrial Appendage Occlusion</atitle><jtitle>JACC. Cardiovascular interventions</jtitle><addtitle>JACC Cardiovasc Interv</addtitle><date>2021-03-08</date><risdate>2021</risdate><volume>14</volume><issue>5</issue><spage>554</spage><epage>561</epage><pages>554-561</pages><issn>1936-8798</issn><eissn>1876-7605</eissn><abstract>The aim of this study was to examine the association between percutaneous left atrial appendage occlusion (LAAO) procedural volume and in-hospital outcomes.
Several studies have demonstrated an inverse volume-outcome relationship for patients undergoing invasive cardiac procedures. Whether a similar association exists for percutaneous LAAO remains unknown.
Patients undergoing LAAO in 2017 were identified in the Nationwide Readmissions Database. Hospitals were categorized into 3 groups on the basis of tertiles of annual procedural volume: low (5 to 15 cases/year), medium (17 to 31 cases/year), and high (32 to 211 cases/year). Multivariate hierarchical logistic regression and restricted cubic spline analyses were performed to examine the association of hospital LAAO volume and outcomes. The primary outcome was in-hospital major adverse events (MAE), defined as a composite of mortality, stroke or transient ischemic attack, bleeding or transfusion, vascular complications, myocardial infarction, systemic embolization, and pericardial effusion or tamponade requiring pericardiocentesis or surgery.
This study included 5,949 LAAO procedures performed across 196 hospitals with a median annual procedural volume of 41 (interquartile range: 25 to 67). Low-volume hospitals had higher rates of in-hospital MAE (9.5% vs. 5.6%; p < 0.001), stroke or transient ischemic attack (2.1% vs. 1.3%; p = 0.049), and bleeding or transfusion (6.1% vs. 3.5%; p = 0.002) compared with high-volume hospitals. No differences were noted for other components of MAE and index length of stay. On multivariate analysis, higher procedural volume was associated with lower rates of in-hospital MAE, with an adjusted odds ratio for medium versus low volume of 0.69 (95% confidence interval: 0.46 to 1.04; p = 0.08) and for high versus low volume of 0.55 (95% confidence interval: 0.37 to 0.82; p = 0.003).
Higher hospital procedural volume is associated with better outcomes for LAAO procedures. Further studies are needed to determine if this relationship persists for long-term outcomes.
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| ispartof | JACC. Cardiovascular interventions, 2021-03, Vol.14 (5), p.554-561 |
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| source | Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | hospital volume left atrial appendage occlusion outcomes Watchman |
| title | Association of Hospital Procedural Volume With Outcomes of Percutaneous Left Atrial Appendage Occlusion |
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