Operator Volume and Mortality After PCI
What is the association of operator volume with independently reported 30-day mortality in a contemporary percutaneous coronary intervention (PCI) cohort?
The investigators conducted an observational cohort study and analyzed procedures recorded in the British Cardiovascular Intervention Society PCI database from 2013 to 2014 in England and Wales. Mixed-effects multiple logistic regression modeling was used to account for operator and center-level effects and to adjust for potential confounders. Volume was defined as the total number of procedures the operator was responsible for in the previous 12 months.
A total of 133,970 procedures were analyzed. Median volume across all procedures was 178 per year (interquartile range, 128–239). The 30-day mortality rate was 2.6%. After adjustment for case-mix, the association between volume and mortality was negligible (odds ratio per 100 procedures, 0.99; 95% confidence interval, 0.93–1.05; p = 0.725). Sensitivity analyses showed similar results among high-risk PCI subsets and in-hospital outcomes.
The authors concluded that there is no evidence that mortality differs by operator volume.
This contemporary nationally representative study from the United Kingdom showed no relationship between 30-day mortality following PCI and the number of cases performed by a PCI operator. Furthermore, similar results were obtained in analyses of acute coronary syndrome-only and primary PCI-only procedures, and of center-reported in-hospital mortality and in-hospital major adverse cardiac events. One caveat is that there were only a few truly low-volume operators. These data appear to suggest that increasing PCI volume is not associated with better mortality outcomes in the contemporary era. Volume-related outcome patterns in the PCI setting need re-assessment and have implications for credentialing and recertification requirements.
Keywords: Acute Coronary Syndrome, Certification, Credentialing, Hospital Mortality, Mortality, Outcome Assessment (Health Care), Percutaneous Coronary Intervention
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