title: Relationship between procedural adverse events associated with cardiac catheterization for congenital heart disease and operator factors: results of a multi-institutional registry (C3PO).
abstract: BACKGROUND
  Data examining the effect of operator years in practice and volume on adverse events (AE) after cardiac catheterization in patients with congenital heart disease is limited.
  
  
  RESULTS
  Data were prospectively collected using a multi-center registry (C3PO). 10,885 catheterizations performed between 02/07 and 06/10 at eight institutions were included. AE rates were risk-adjusted for hemodynamic vulnerability, procedure type risk group, and age and compared between operators with different years in practice (YIP) and volume. AE occurred in 13% of procedures. Operators with less than five YIP had higher adjusted odds of any AE (OR 1.42, 95% CI 1.14-1.77) or a high severity AE (OR 1.35, 95% CI 1.04-1.75), when compared with operators with 5 to less than 25 YIP (5 < 25), while operators with ≥25 YIP had higher odds of a high severity (but not any) AE (OR 1.39, 95% CI 1.08-1.80). Operators with <5 YIP had a higher percentage of preventable AE (out of all AE, 16% vs. 8%, P < 0.001) as well as higher odds of vascular or cardiac trauma (OR 1.81, 95% CI 1.11-2.97), or technical AE (OR 1.98, 95% CI 1.31-2.99) when compared with operators with 5 < 25 YIP. There was no consistent relationship between operator volume, and incidence of AE.
  
  
  CONCLUSIONS
  Operators with less than 5 years in practice have higher risk-adjusted AE rates. While an important consideration in guiding and mentoring operators with fewer years in practice, it is important to emphasize that reporting adverse events does not take into account procedural efficacy.
authors: The Heart Center, Nationwide Children's Hospital, Columbus, Ohio.
authors: Ralf J
authors: RJ
authors: Holzer
authors: Kimberlee
authors: K
authors: Gauvreau
authors: Jacqueline
authors: J
authors: Kreutzer
authors: John W
authors: JW
authors: Moore
authors: Doff B
authors: DB
authors: McElhinney
authors: Lisa
authors: L
authors: Bergersen
mesh_terms: D000367:Age Factors; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002983:Clinical Competence; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D016015:Logistic Models; D009048:Motor Skills; D016017:Odds Ratio; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D014481:United States
keywords: adverse events; cardiac catheterization; congenital heart disease; operator years in practice