Association of Hospital Procedural Volume With Outcomes of Left Ventricular Assist Device Placement.

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BACKGROUND: With the advancement in device technology, the use of durable left ventricular assist devices (LVADs) has increased significantly in recent years. However, there is a dearth of evidence to conclude whether patients who undergo LVAD implantation at high-volume centers have better clinical outcomes as compared with those receiving care at low or medium-volume centers.

METHODS: We analyzed the hospitalizations using Nationwide Readmission Database for the year 2019 for new LVAD implantation. Baseline comorbidities and hospital characteristics were compared between low (1-5 procedures/year), medium (6-16 procedures/year), and high-volume (17-72 procedures/year) hospitals. The volume-outcome relationship was analyzed using the annualized hospital volume as a categorical variable (tertiles) as well as a continuous variable. Multilevel mixed-effect logistic regression and negative binomial regression models were used to determine the association of hospital volume and outcomes with tertile 1 (low-volume hospitals) as the reference category.

RESULTS: A total of 1533 new LVAD procedures were included in the analysis. The inpatient mortality was lower in the high-volume centers compared with the low-volume centers (9.04% vs. 18.49%, aOR 0.41, CI 0.21 - 0.80, p= 0.009). There was a trend towards lower mortality in medium-volume centers compared with low-volume centers; however, it did not reach statistical significance (13.27% vs. 18.49%, aOR 0.57, CI 0.27 - 1.23, p=0.153). Similar results were seen for major adverse events (composite of stroke/transient ischemic attack and inhospital mortality). There was no significant difference in bleeding/transfusion, acute kidney injury, vascular complications, pericardial effusion/hemopericardium/tamponade, length of stay, cost, and 30-day readmission rate among medium or high-volume centers compared to the low-volume centers.

CONCLUSION: Our findings indicate lower inpatient mortality in high-volume LVAD implantation centers and a trend towards lower mortality in medium-volume LVAD implantation centers compared to lower-volume centers.

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Journal of cardiac failure





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