Association of Hospital Procedural Volume With Outcomes of Left Ventricular Assist Device Placement.
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.
Journal of cardiac failure
Sagheer, S., Minhas, A., Zaidi, S., Shah, I., Ahuja, K. R., Ahuja, S., Nazir, S., Talha, K., Dani, S., Fudim, M., Abramov, D., Virani, S., & Wasty, N. (2023). Association of Hospital Procedural Volume With Outcomes of Left Ventricular Assist Device Placement.. Journal of cardiac failure, 29 (11), 1531-1538. https://doi.org/https://doi.org/10.1016/j.cardfail.2023.06.017