Document Detail


Hospital percutaneous coronary intervention volume and patient mortality, 1998 to 2000: does the evidence support current procedure volume minimums?
MedLine Citation:
PMID:  15145095     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The aim of this study was to evaluate current American College of Cardiology/American Heart Association (ACC/AHA) hospital percutaneous coronary intervention (PCI) volume minimum recommendations.
BACKGROUND: In order to reduce procedure-associated mortality, ACC/AHA guidelines recommend that hospitals offering PCIs perform at least 400 PCIs annually. It is unclear whether this volume standard applies to current practice.
METHODS: We conducted a retrospective analysis of the Agency for Healthcare Research and Quality's Nationwide In-patient Sample hospital discharge database to evaluate in-hospital mortality among patients (n = 362748) who underwent PCI between 1998 and 2000 at low (5 to 199 cases/year), medium (200 to 399 cases/year), high (400 to 999 cases/year), and very high (1000 cases or more/year) PCI volume hospitals.
RESULTS: Crude in-hospital mortality rates were 2.56% in low-volume hospitals, 1.83% in medium-volume hospitals, 1.64% in high-volume hospitals, and 1.36% in very high-volume hospitals (p < 0.001 for trend). Compared with patients treated in high-volume hospitals (odds ratio [OR] 1.00, referent), patients treated in low-volume hospitals remained at increased risk for mortality after adjustment for patient characteristics (OR 1.21, 95% confidence interval [CI] 1.06 to 1.28). However, patients treated in medium-volume hospitals (OR 1.02, 95% CI 0.92 to 1.14) and patients treated in very high-volume hospitals (OR 0.94, 95% CI 0.85 to 1.03) had a comparable risk of mortality. Findings were similar when high- and very high-volume hospitals were pooled together.
CONCLUSIONS: We found no evidence of higher in-hospital mortality in patients undergoing PCI at medium-volume hospitals compared with patients treated at hospitals with annual PCI volumes of 400 cases of more, suggesting current ACC/AHA PCI hospital volume minimums may merit reevaluation.
Authors:
Andrew J Epstein; Saif S Rathore; Kevin G M Volpp; Harlan M Krumholz
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  43     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-05-17     Completed Date:  2004-06-29     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1755-62     Citation Subset:  AIM; IM    
Affiliation:
Department of Health Care Systems, Wharton School of Business, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon, Coronary / mortality*,  utilization*
Female
Health Planning Guidelines
Hospitals / statistics & numerical data,  utilization*
Humans
Male
Outcome Assessment (Health Care)
Quality of Health Care*
Retrospective Studies
United States
Grant Support
ID/Acronym/Agency:
GM07205/GM/NIGMS NIH HHS; T32 GM007205-35/GM/NIGMS NIH HHS; T32-HS00009/HS/AHRQ HHS
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2004 May 19;43(10):1763-4   [PMID:  15145096 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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