title: The relation between hospital procedure volume and complications of cardioverter-defibrillator implantation from the implantable cardioverter-defibrillator registry.
abstract: OBJECTIVE
  We sought to examine the relationship between hospital implantable cardioverter-defibrillator (ICD) implantation volume and procedural complications in a contemporary, representative population.
  
  
  BACKGROUND
  Hospitals that perform higher volumes of procedures generally have better clinical outcomes.
  
  
  METHODS
  We examined initial ICD implantations between January 2006 and December 2008 at hospitals participating in the NCDR (National Cardiovascular Data Registry) ICD Registry and evaluated the relationship between hospital annual implant volume and in-hospital adverse outcomes.
  
  
  RESULTS
  The rate of adverse events declined progressively with increasing procedure volume (p trend < 0.0001). This relationship remained significant (p trend < 0.0001) after adjustment for patient clinical characteristics, operator characteristics, and hospital characteristics. The volume-outcome relationship was evident for all ICD subtypes, including single-chamber (p trend = 0.004), dual-chamber (p trend < 0.0001), and biventricular ICDs (p trend = 0.02).
  
  
  CONCLUSIONS
  Patients who have an ICD implanted at a high-volume hospital are less likely to have an adverse event associated with the procedure than patients who have an ICD implanted at a low-volume hospital.
authors.affiliation: Stanford University School of Medicine, California, USA. jfreeman@stanford.edu
authors.forename: James V
authors.initials: JV
authors.lastname: Freeman
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hlatky
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012042:Registries; D015996:Survival Rate; D016526:Workload / Q000706:statistics & numerical data*