Elsevier

American Heart Journal

Volume 183, January 2017, Pages 118-128
American Heart Journal

Clinical Investigation
Relationship between hospital procedure volume and complications following congenital cardiac catheterization: A report from the IMproving Pediatric and Adult Congenital Treatment (IMPACT) registry

https://doi.org/10.1016/j.ahj.2016.10.004Get rights and content

Background

The association between institutional volume and outcomes has been demonstrated for cardiac catheterization among adults, but less is known about this relationship for patients with congenital heart disease (CHD) undergoing cardiac catheterization.

Methods

Within the IMPACT registry, we identified all catheterizations between January 2011 and March 2015. Hierarchical logistic regression, adjusted for patient and procedural characteristics, was used to determine the association between annual catheterization lab volume and occurrence of a major adverse event (MAE).

Results

Of 56,453 catheterizations at 77 hospitals, an MAE occurred in 1014 (1.8%) of cases. In unadjusted analysis, a MAE occurred in 2.8% (123/4460) of cases at low-volume hospitals (<150 procedures annually), as compared with 1.5% (198/12,787), 2.0% (431/21,391), and 1.5% (262/17,815) of cases at medium- (150-299 annual procedures), high- (300-499 annual procedures), and very-high-volume (≥500 procedures annually) hospitals, respectively, P < .001. After multivariable adjustment, this significant relationship between annual procedure volume and occurrence of an MAE persisted. Compared to low-volume programs, the odds of an MAE was 0.55 (95% CI 0.35-0.86, P = .008), 0.62 (95% CI 0.41-0.95, P = .03), and 0.52 (95% CI 0.31-0.90, P = .02) at medium-, high-, and very-high-volume programs, respectively.

Conclusions

Although the risk of MAE after cardiac catheterization in patients with CHD is low at all hospitals, it is higher among hospitals with fewer than 150 cases annually. These results support the notion that centers meeting this threshold volume for congenital cardiac catheterizations may achieve improved patient outcomes.

Section snippets

Study population

IMPACT is a US-based registry collecting information on pediatric and adult patients with CHD undergoing diagnostic or interventional cardiac catheterization. Details regarding registry development and its basic design have been previously published.13 In brief, centers performing cardiac catheterization on pediatric patients with congenital or acquired heart disease and adult patients with CHD are eligible for voluntary enrollment in IMPACT. Participating centers collect detailed information

Results

The mean annual case volume per hospital was 286 ± 214, and the median annual case volume was 240 (inter-quartile range: 130 to 387; total range: 24 to 1233) (Figure 1). Among the 77 hospitals, 24 (31.2% of hospitals and 7.9% of cases) were low-volume centers, 22 (28.6% of hospitals and 22.7% of cases) medium-sized centers, 23 (29.9% of hospitals and 37.9% of cases) high-volume centers, and 8 (10.4% of hospitals and 31.6% of cases) very high-volume centers.

Of the 56,453 cardiac catheterization

Discussion

In a large multicenter registry of cardiac procedures among pediatric and adult patients with CHD, we found that cardiac catheterization procedures were generally safe with overall peri-procedural rates of major adverse events of less than 2%. Despite the low rate, the adjusted odds of a major adverse event peri-procedurally, when excluding death, were 38% to 48% lower at hospitals with annual case volumes exceeding 150 cardiac catheterization procedures. While the absolute differences were

Conclusions

Using a large multicenter registry, we found that centers performing at least 150 cardiac catheterizations on pediatric and adult patients with CHD had a numerically small but statistically significantly lower rate of adverse events as compared with low-volume centers. Our findings provide some support for regionalizing care at centers performing more than 150 cases per year, but other issues of access to care and patient preference will also need to be considered.

Disclosures

  • Dr Spertus discloses grant funding from NIH, AHA, Lilly, Gillead, Amorcyte and Genentech. He serves on Scientific Advisory Boards for United Healthcare, Novartis, Regeneron and Amgen. He serves as a paid editor for Circulation: Cardiovascular Quality and Outcomes and has intellectual property rights for the Seattle Angina Questionnaire, Kansas City Cardiomyopathy Questionnaire, Peripheral Artery Questionnaire and an equity interest in Health Outcomes Sciences.

  • Dr Glatz is a consultant for

References (21)

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Funding/Support:

  • Dr Jayaram was supported by a T32 training grant (HL110837) from the National Heart Lung and Blood Institute.

  • Dr O'Byrne received support from the NIH [T32 HL007915] and Entelligence Young Investigator grant.

  • Dr Spertus is the PI of the analytic center that is under contract with the American College of Cardiology Foundation to analyze the NCDR.

  • Dr Chan is supported by an R01 Award (1R01HL123980) from the National Heart Lung and Blood Institute.

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