title: Effect of Hospital Volume on Outcomes of Transcatheter Aortic Valve Implantation.
abstract: Transcatheter aortic valve implantation (TAVI) is associated with a significant learning curve. There is paucity of data regarding the effect of hospital volume on outcomes after TAVI. This is a cross-sectional study based on Healthcare Cost and Utilization Project's Nationwide Inpatient Sample database of 2012. Subjects were identified by International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes, 35.05 (Trans-femoral/Trans-aortic Replacement of Aortic Valve) and 35.06 (Trans-apical Replacement of Aortic Valve). Annual hospital TAVI volumes were calculated using unique identification numbers and then divided into quartiles. Multivariate logistic regression models were created. The primary outcome was inhospital mortality; secondary outcome was a composite of inhospital mortality and periprocedural complications. Length of stay (LOS) and cost of hospitalization were assessed. The study included 1,481 TAVIs (weighted n = 7,405). Overall inhospital mortality rate was 5.1%, postprocedural complication rate was 43.4%, median LOS was 6 days, and median cost of hospitalization was $51,975. Inhospital mortality rates decreased with increasing hospital TAVI volume with a rate of 6.4% for lowest volume hospitals (first quartile), 5.9% (second quartile), 5.2% (third quartile), and 2.8% for the highest volume TAVI hospitals (fourth quartile). Complication rates were significantly higher in hospitals with the lowest volume quartile (48.5%) compared to hospitals in the second (44.2%), third (39.7%), and fourth (41.5%) quartiles (p <0.001). Increasing hospital volume was independently predictive of shorter LOS and lower hospitalization costs. In conclusion, higher annual hospital volumes are significantly predictive of reduced postprocedural mortality, complications, shorter LOS, and lower hospitalization costs after TAVI.
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
authors.affiliation: Internal Medicine Department, Staten Island University Hospital, Staten Island, New York.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.affiliation: Internal Medicine Department, Western Reserve Health System, Youngstown, Ohio.
authors.forename: Samir V
authors.initials: SV
authors.lastname: Patel
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Sunny
authors.initials: S
authors.lastname: Jhamnani
authors.affiliation: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Internal Medicine Department, University of Louisville, Louisville, Kentucky.
authors.forename: Sadip
authors.initials: S
authors.lastname: Pant
authors.affiliation: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nish
authors.initials: N
authors.lastname: Patel
authors.affiliation: Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: Internal Medicine Department, Mount Sinai St Luke's Roosevelt, New York, New York.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Internal Medicine Department, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Sohilkumar
authors.initials: S
authors.lastname: Manvar
authors.affiliation: Internal Medicine Department, UT Houston Health Science Center, Houston, Texas.
authors.forename: Abhijeet
authors.initials: A
authors.lastname: Dhoble
authors.affiliation: Internal Medicine Department, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Internal Medicine Department, New York Medical College, Valhalla, New York.
authors.forename: Chirag
authors.initials: C
authors.lastname: Savani
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Jay
authors.initials: J
authors.lastname: Patel
authors.affiliation: Internal Medicine Department, Med Star Washington Hospital Center, Washington, D.C.
authors.forename: Ankit
authors.initials: A
authors.lastname: Chothani
authors.affiliation: Internal Medicine Department, Prince George's Hospital Center, Cheverly, Maryland.
authors.forename: Ghanshyambhai T
authors.initials: GT
authors.lastname: Savani
authors.affiliation: Cardiology Department, Mayo Clinic, Rochester, Minnesota.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Jeptha
authors.initials: J
authors.lastname: Curtis
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Abeel A
authors.initials: AA
authors.lastname: Mangi
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Michael
authors.initials: M
authors.lastname: Cleman
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut. Electronic address: john.k.forrest@yale.edu.
authors.forename: John K
authors.initials: JK
authors.lastname: Forrest
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000191:economics / Q000401:mortality / Q000601:surgery*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D016896:Treatment Outcome