title: Learning curve in transradial cardiac catheterization: procedure-related parameters stratified by operators' transradial volume.
abstract: OBJECTIVE
  To determine whether radial artery access is associated with a reduction in fluoroscopy time, procedure time, and other procedural variables over a 27-month period during which the radial artery approach was incorporated in a single academic Medical Center.
  
  
  BACKGROUND
  Although previous studies have demonstrated a relationship between increased volume and decreased procedural time, no studies have looked at the integration of radial access over time.
  
  
  METHODS
  Data were collected from consecutive patients who presented to the Vanderbilt University Medical Center cardiac catheterization laboratory from January 1, 2009 to April 1, 2011. Patients who underwent radial access diagnostic catheterization with and without percutaneous coronary intervention were included in this study. A total of 1112 diagnostic cardiac catheterizations through the radial access site were analyzed. High-volume, intermediate-volume, and low-volume operators were grouped based on the percentage of procedures performed through a radial approach.
  
  
  RESULTS
  From 2009 to 2011, there was a significant decrease in fluoroscopy time in all operator groups for diagnostic catheterization (P=.035). The high-volume operator group had 1.88 and 3.66 minute reductions in fluoroscopy time compared to the intermediate- and low-volume operator groups, respectively (both P<.001). Likewise, the intermediate-volume operator group had a 1.77 minute improvement compared to the low-volume operator group, but this did not reach statistical significance (P=.102). The improvement in fluoroscopy time and other procedure-related parameters was seen after approximately 25 cases with further improvement after 75 cases.
  
  
  CONCLUSIONS
  The incorporation of the radial access approach in the cardiac catheterization laboratory led to a decrease in fluoroscopy time for each operator and operator group over the last 3 years. Our data demonstrated that higher-volume radial operators have better procedure, room, and fluoroscopy times when compared to intermediate- and low-volume operators. However, lower-volume operators have a reduction in procedure-related parameters with increased radial cases. Number of procedures needed to become sufficient was demonstrated in the current study.
authors.affiliation: Vanderbilt University Medical Center, Department of Internal Medicine, Division of Cardiovascular Medicine, 2200 Pierce Avenue, Nashville, TN 37232, USA. ehab.kasasbeh@vanderbilt.edu
authors.forename: Ehab S
authors.initials: ES
authors.lastname: Kasasbeh
authors.forename: Babar
authors.initials: B
authors.lastname: Parvez
authors.forename: Robert L
authors.initials: RL
authors.lastname: Huang
authors.forename: Michele Marie
authors.initials: MM
authors.lastname: Hasselblad
authors.forename: Mark D
authors.initials: MD
authors.lastname: Glazer
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Salloum
authors.forename: John H
authors.initials: JH
authors.lastname: Cleator
authors.forename: David X
authors.initials: DX
authors.lastname: Zhao
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D005471:Fluoroscopy; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data; D006801:Humans; D059032:Learning Curve; D008875:Middle Aged; D017534:Radial Artery; D012189:Retrospective Studies; D013038:Specialization; D013997:Time Factors