Association of Hospital Procedural Volume With Outcomes of Percutaneous Left Atrial Appendage Occlusion.

Authors

Salik Nazir, Division of Cardiology, University of Toledo Medical Center, Toledo, Ohio, USA
Keerat R. Ahuja, Division of Cardiology, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USAFollow
Dhaval Kolte, Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Toshiaki Isogai, Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Nobuaki Michihata, Department of Health Services Research, University of Tokyo, Tokyo, Japan
Anas M Saad, Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
P Kasi Ramanathan, Promedica Toledo Hospital, Toledo, Ohio, USA
Amar Krishnaswamy, Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Oussama M Wazni, Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Walid I Saliba, Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Rajesh Gupta, Division of Cardiology, University of Toledo Medical Center, Toledo, Ohio, USA
Samir R Kapadia, Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA

Document Type

Article

Publication Date

3-8-2021

Abstract

OBJECTIVES: The aim of this study was to examine the association between percutaneous left atrial appendage occlusion (LAAO) procedural volume and in-hospital outcomes.

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.

Publication Title

JACC Cardiovasc Interv

Volume

14

Issue

5

First Page

554

Last Page

561

Recommended Citation

Nazir, S., Ahuja, K. R., Kolte, D., Isogai, T., Michihata, N., Saad, A., Ramanathan, P., Krishnaswamy, A., Wazni, O., Saliba, W., Gupta, R., & Kapadia, S. (2021). Association of Hospital Procedural Volume With Outcomes of Percutaneous Left Atrial Appendage Occlusion.. JACC Cardiovasc Interv, 14 (5), 554-561. https://doi.org/DOI: 10.1016/j.jcin.2020.11.029