NCDR Study Finds PCI Operators Perform Low Volume of PCI Procedures Annually

Many PCI operators in the U.S. perform fewer than the recommended number of PCI procedures annually, according to a study published June 12 in the Journal of the American College of Cardiology.

Using data from ACC’s CathPCI Registry, Alexander C. Fanaroff, MD, et al., looked at operator annual PCI volume between July 1, 2009 and March 31, 2015. Operators were divided into low- (less than 50 PCIs per year), intermediate- (50 to 100 PCIs per year) and high- (more than 100 PCIs per year) volume groups.

Results showed that the median annual number of procedures performed per operator was 59, and 44 percent of operators performed less than 50 PCI procedures per year – the number of procedures recommended by the ACC/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures. In addition, low-volume operators more frequently performed emergency and primary PCI procedures and practiced at hospitals with lower annual PCI volumes.

The adjusted risk of in-hospital mortality was higher for PCI procedures performed by low- and intermediate-volume operators compared with those performed by high-volume operators (adjusted odds ratio: 1.16 for low versus high; adjusted odds ratio: 1.05 for intermediate vs. high volume).

The authors add that “although absolute risk differences are small and may be partially explained by unmeasured differences in case mix between operators, there remains an inverse relationship between PCI operator volume and in-hospital mortality that persisted in risk-adjusted analyses.”

Moving forward, they conclude that “future studies should identify measurable process and outcome variables other than case volume that better correlate with operator competency.”

In a related editorial comment, Dharam J. Kumbhani, MD, SM, FACC, and Brahmajee K. Nallamothu, MD, FACC, explain that, “The bottom line is that we need to seriously rethink our obsession with volume benchmarks, a metric that we have assiduously clung to for the past several decades. Volume may be among the factors, but it should be only considered under a quality assessment program that is more comprehensive. The practice of interventional cardiology in 2017 looks very different from its inception in 1977, and it is high time that quality assessment is updated from 1977 to 2017 as well.” 

Keywords: Benchmarking, Clinical Competence, Coronary Vessels, Diagnosis-Related Groups, Hospital Mortality, Obsessive Behavior, Odds Ratio, Registries, Risk, National Cardiovascular Data Registries, CathPCI Registry, Angiography

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