Carotid artery stenting in the nation: the influence of hospital and physician volume on outcomes.
OBJECTIVE
To assess national outcomes of carotid artery stenting (CAS) with respect to hospital and practitioner volume.


METHODS
The 2005 to 2006 Nationwide Inpatient Sample (NIS) was used to assess CAS with respect to hospital volume, physician volume, and associated complications.


RESULTS
Eighteen thousand five hundred ninety-nine CAS interventions were identified. The top 25% was used to define high-volume hospitals (>60 CAS/2 years) and practitioners (>30 CAS/2 years). The stroke rate after CAS was significantly different between low- and high-volume hospitals (2.35% vs 1.78%, respectively; P = .0206). The stroke rate after CAS was also significantly different between low- and high-volume practitioners (2.19% vs 1.51%, P = .0243). Hospital resource use varied significantly between low- and high-volume hospitals (length of stay [LOS]: 1.64 +/- 2.10 vs 1.45 +/- 11.21, P = .0006; total charges: $32 261 +/- 20 562 vs $30 131 +/- 19 592, P = .0047) and practitioners (LOS: 1.70 +/- 2.14 vs 1.36 +/- 1.36; P < .0001; total charges: $33 762 +/- 21 081 vs $23 957 +/- 19 713; P < .0001).


CONCLUSIONS
This analysis demonstrates that hospital and physician volume are associated with outcomes and utilization after CAS. High-volume hospitals and practitioners were associated with lower procedure stroke rates and decreased hospital resource utilization.
Vogel
Todd R
TR
Division of Vascular Surgery, UMDNJ-Robert Wood Johnson Medical School, The Surgical Outcomes Research Group, New Brunswick, New Jersey, USA. tvogel@excite.com
Dombrovskiy
Viktor Y
VY
Graham
Alan M
AM
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation* / Q000706:statistics & numerical data; D002340:Carotid Artery Diseases / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D002983:Clinical Competence / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D018570:Risk Assessment; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology