title: Influence of hospital volume on outcomes of percutaneous atrial septal defect and patent foramen ovale closure: a 10-years US perspective.
abstract: BACKGROUND
  Contemporary data regarding percutaneous closure of atrial septal defect/patent foramen ovale (ASD/PFO) are lacking. We evaluated the current trends in utilization of ASD/PFO closure in adults and investigated the effect of annual hospital volume on in-hospital outcomes.
  
  
  METHODS
  We queried the Nationwide Inpatient Sample between the years 2001 and 2010 using the International Classification of Diseases (ICD-9-CM) procedure code for percutaneous closure of ASD/PFO with device. Hierarchical mixed effects models were generated to identify the independent multivariate predictors of outcomes.
  
  
  RESULTS
  A total of 7,107 percutaneous ASD/PFO closure procedures (weighted n = 34,992) were available for analysis. A 4.7-fold increase in the utilization of this procedure from 3/million in 2001 to 14/million adults in 2010 in US (P < 0.001) was noted. Overall, percutaneous ASD/PFO closure was associated with 0.5% mortality and 12% in-hospital complications. The utilization of intracardiac echocardiography (ICE) increased 15 fold (P < 0.001) during the study period. The procedures performed at the high volume hospitals [2nd (14-37 procedures/year) and 3rd (>38 procedures/year) tertile] were associated with significant reduction in complications, length of stay and cost of hospitalization when compared to those performed at lowest volume centers (<13 procedures/year). Majority (70.5%) of the studied hospitals were found to be performing <10 procedures/year hence deviating from the ACC/AHA/SCAI clinical competency guidelines.
  
  
  CONCLUSIONS
  Low hospital volume is associated with an increased composite (mortality and procedural complications) adverse outcome following ASD/PFO closure. In the interest of patient safety, implementation of the current guidelines for minimum required annual hospital volume to improve clinical outcomes is warranted.
authors.affiliation: Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.forename: Ankit
authors.initials: A
authors.lastname: Chothani
authors.forename: Kathan
authors.initials: K
authors.lastname: Mehta
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.forename: Neeraj
authors.initials: N
authors.lastname: Shah
authors.forename: Ghanshyambhai T
authors.initials: GT
authors.lastname: Savani
authors.forename: Ankit
authors.initials: A
authors.lastname: Rathod
authors.forename: Sohilkumar
authors.initials: S
authors.lastname: Manvar
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.forename: Vinaykumar
authors.initials: V
authors.lastname: Panchal
authors.forename: Jay
authors.initials: J
authors.lastname: Patel
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
authors.forename: William
authors.initials: W
authors.lastname: O'Neill
authors.forename: Eduardo
authors.initials: E
authors.lastname: De Marchena
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging / Q000191:economics / Q000628:therapy*; D017048:Health Care Costs; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000191:economics / Q000628:therapy*; D061847:Hospitals, High-Volume; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D061214:Patient Safety; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D055989:Septal Occluder Device; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014481:United States
keywords: atrial septal defect; closure complication; cost; length of stay; patent foramen ovale; percutaneous