PCI Operator Volume and Clinical Outcomes in the US
What is the relationship between percutaneous coronary intervention (PCI) operator volumes and in-hospital outcomes in the United States?
Study investigators analyzed data from 2009-2015 using the National Cardiovascular Data Registry (NCDR) to examine the association between annual PCI operator volume and in-hospital outcomes including mortality. Operators were divided into low- (<50 PCIs), intermediate- (50-100 PCIs per year) and high-volume (>100 PCIs per year). Multivariate logistic regression modeling was used to perform an adjusted analysis of operator volume and in-hospital mortality.
Over the study period, 10,496 operators performed 3,747,866 PCIs at 1,584 NCDR sites. Median operator volume was 59 PCIs per year with 44% of the operators being low-, 29% being intermediate-, and 27% being high-volume operators. There was considerable regional variation in operator volumes. Low-volume operators were more likely to perform emergent and primary PCI procedures at low-volume hospitals. Adjusted risk of in-hospital mortality was higher for PCI procedures performed by low- and intermediate-volume operators compared with high-volume operators (adjusted odds ratio [OR], 1.16 [1.12-1.21] for low- vs. high-volume; 1.05 [1.02-1.09] for intermediate- vs. high-volume).
The authors concluded that a substantial number of PCI operators perform fewer than the recommended number of PCIs per year, and low-volume operators perform a disproportionate number of emergent cases. Overall adjusted differences were small; however, there was an inverse relationship between PCI operator volumes and in-hospital mortality.
This comprehensive volume-outcome analysis from the NCDR highlights the following: 1) A significant number of PCI operators do not meet the current professional guideline recommendations of >50 PCIs per year; 2) Using the Dartmouth Atlas of Healthcare, there is significant regional variation in operator volumes; 3) Although absolute differences were small, there was an inverse relationship between PCI operator volumes and in-hospital mortality; 4) Low-volume operators performing PCI at low-volume hospitals had 28% higher mortality compared with high-volume operators performing PCIs at high-volume hospitals; and 5) Focusing on improving process and outcome measures for all PCI operators regardless of volume may be more beneficial than mandating volume thresholds.
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