Relationship Between Hospital Procedure Volume and Complications Following Congenital Cardiac Catheteriazation: A Report from the IMPACT Registry
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Abstract
The association between institutional volume and outcomes has been demonstrated for many procedures within the field of cardiology, but whether this relationship exists within the field of congenital cardiac catheterization is unknown. Using the IMPACT® (Improving Pediatric and Adult Congenital Treatment) Registry, we identified all congenital cardiac catheterizations between January 2011 and December 2013 at 64 institutions. Programs were categorized according to their annual catheterization lab volume as small (<150 cases per year), medium (150 to 300 cases per year), large (300- 500 cases per year), and very large (>500 cases per year). 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. Among the 33,825 catheterization cases included in the study cohort, a major adverse event occurred in 711 (2.1%) cases. In unadjusted analysis, major adverse events differed based upon annual volume, with a major adverse event occurring in 79 (2.8%) cases at small, 145 (2.3%) cases at medium, 234 (2.1%) cases at large, and 253 (1.9%) cases at very-large programs (p=0.01). After adjustment for patient and procedural risk factors, there was no association between annual procedure volume and occurrence of a major adverse event (odds ratio 0.96 [95% Confidence Interval=0.90, 1.04] per increase in annual volume of 100, p=0.32). There was no difference in the volume-outcome relationship by procedure severity (interaction p=0.49). The unadjusted risk of adverse events is lower in centers performing more catheterizations for congenital heart disease. However, after adjustment for patient- and procedure-level factors, we were unable to identify a significant association between center volume and outcome. The hospital sample size and low event rate may have limited our ability to detect significant differences.
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Introduction -- Methods -- Results -- Discussion -- Conclusion
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M.S.