title: Variability in utilization of drug eluting stents in United States: Insights from nationwide inpatient sample.
abstract: OBJECTIVE
  We studied the trends and predictors of drug eluting stent (DES) utilization from 2006 to 2011 to further expound the inter-hospital variability in their utilization.
  
  
  BACKGROUND
  We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) between 2006 and 2011 using ICD-9-CM procedure code, 36.06 (bare metal stent) or 36.07 (drug eluting stents) for Percutaneous Coronary Intervention (PCI). Annual hospital volume was calculated using unique identification numbers and divided into quartiles for analysis.
  
  
  RESULTS
  We built a hierarchical two level model adjusted for multiple confounding factors, with hospital ID incorporated as random effects in the model. About 665,804 procedures (weighted n = 3,277,884) were analyzed. Safety concerns arising in 2006 reduced utilization DES from 90% of all PCIs performed in 2006 to a nadir of 69% in 2008 followed by increase (76% of all stents in 2009) and plateau (75% in 2011). Significant between-hospital variation was noted in DES utilization irrespective of patient or hospital characteristics. Independent patient level predictors of DES were (OR, 95% CI, P-value) age (0.99, 0.98-0.99, <0.001), female(1.12, 1.09-1.15, <0.001), acute myocardial infarction(0.75, 0.71-0.79, <0.001), shock (0.53, 0.49-0.58, <0.001), Charlson Co-morbidity index (0.81,0.77-0.86, <0.001), private insurance/HMO (1.27, 1.20-1.34, <0.001), and elective admission (1.16, 1.05-1.29, <0.001). Highest quartile hospital (1.64, 1.25-2.16, <0.001) volume was associated with higher DES placement.
  
  
  CONCLUSIONS
  There is significant between-hospital variation in DES utilization and a higher annual hospital volume is associated with higher utilization rate of DES. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.affiliation: Department of Cardiology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
authors.affiliation: Department of Internal Medicine, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana.
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Vikas
authors.identifier: http://orcid.org/0000-0002-7776-5111
authors.initials: V
authors.lastname: Singh
authors.affiliation: Department of Internal Medicine, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Ankit
authors.initials: A
authors.lastname: Chothani
authors.affiliation: Department of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Kanishk
authors.initials: K
authors.lastname: Agnihotri
authors.affiliation: Department of Cardiology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Sunny
authors.initials: S
authors.lastname: Jhamnani
authors.affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Sopan
authors.initials: S
authors.lastname: Lahewala
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Sohilkumar
authors.initials: S
authors.lastname: Manvar
authors.affiliation: Department of Internal Medicine, Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana.
authors.forename: Vinaykumar
authors.initials: V
authors.lastname: Panchal
authors.affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Neil
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana.
authors.forename: Parth
authors.initials: P
authors.lastname: Bhatt
authors.affiliation: Department of Internal Medicine, New York Medical College, Valhalla, New York.
authors.forename: Chirag
authors.initials: C
authors.lastname: Savani
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Jay
authors.initials: J
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, Prince George's Hospital Center, Cheverly, Maryland.
authors.forename: Ghanshyambhai T
authors.initials: GT
authors.lastname: Savani
authors.affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Shantanu
authors.initials: S
authors.lastname: Solanki
authors.affiliation: Department of Internal Medicine, Western Reserve Health System, Youngstown, Ohio.
authors.forename: Samir
authors.initials: S
authors.lastname: Patel
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Amir
authors.initials: A
authors.lastname: Kaki
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Tamam
authors.initials: T
authors.lastname: Mohamad
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Mahir
authors.initials: M
authors.lastname: Elder
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Ashok
authors.initials: A
authors.lastname: Kondur
authors.affiliation: Department of Cardiology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Michael
authors.initials: M
authors.lastname: Cleman
authors.affiliation: Department of Cardiology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: John K
authors.initials: JK
authors.lastname: Forrest
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Theodore
authors.initials: T
authors.lastname: Schreiber
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Cindy
authors.initials: C
authors.lastname: Grines
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D017721:Hospital Costs / Q000639:trends*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D011474:Prosthesis Design; D013997:Time Factors; D014481:United States
keywords: bare metal stent; coronary artery disease; drug eluting stent; health care outcomes