title: Impact of Hospital Volume on Outcomes of Endovascular Stenting for Adult Aortic Coarctation.
abstract: Use of transcatheter endovascular stenting has been increasing in the treatment of coarctation of aorta (CoA). The present study was undertaken on adults with CoA who underwent stent placement from 2000 to 2011 to analyze the relation of hospital volumes to the outcomes of stenting in adults with CoA. It was a retrospective study based on Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) database from 2000 to 2011 and identified subjects using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure code of 747.10 (CoA). Annual hospital volume was calculated using unique hospital identifiers. Weights provided by the Nationwide Inpatient Sample were used to generate national estimates. A total of 105 (weighted 521) subjects were identified with International Classification of Diseases, Ninth Revision, code of 39.90 (Endovascular stent). Hospital volumes were divided into tertiles. We compared the highest tertile (≥3 procedures annually) with other tertiles (<3 procedure annually). The composite outcomes of the analysis were procedure-related complications, length of stay (LOS), and cost in relation to the hospital volume. No inhospital death was reported in either group. Hospitals with ≥3 procedures annually had significantly lower incidence of complications (9.5% vs 23.0%) compared to the hospitals with <3 procedures annually (p-value 0.002). Similar results were obtained after multivariate regression analysis in relation to hospital volume. Shorter LOS and lower cost were observed with annual hospital volume of ≥3 procedures. In conclusion, stenting adults for CoA is remarkably safe, and the outcomes of the procedure have improved in centers with annual hospital volume of ≥3 procedures. There is also decreasing trend of procedure-related complications, shorter LOS, and lower costs compared to centers with annual volume <3 procedures.
authors.affiliation: Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Parth
authors.initials: P
authors.lastname: Bhatt
authors.affiliation: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Department of Public Health, Icahn School of Medicine at Mt. Sinai, New York, New York.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sonani
authors.affiliation: Department of Cardiology, University of Alabama, Birmingham, Alabama.
authors.forename: Aashay
authors.initials: A
authors.lastname: Patel
authors.affiliation: Interventional Cardiology Department, Borgess Medical Center, Kalamazoo, Michigan.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.affiliation: Department of Cardiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: Department of Public Health, New York Medical College, Valhalla, New York.
authors.forename: Chirag
authors.initials: C
authors.lastname: Savani
authors.affiliation: Interventional Cardiology Division, The Everett Clinic, Everett, Washington.
authors.forename: Sunny
authors.initials: S
authors.lastname: Jhamnani
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: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nish
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Cardiology, University of Kentucky, Louisville, Kentucky.
authors.forename: Sadip
authors.initials: S
authors.lastname: Pant
authors.affiliation: Department of Internal Medicine, Western Reserve Health System, Youngstown, Ohio.
authors.forename: Samir
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine/Cardiology, Mount Sinai St Luke's Roosevelt, New York, New York.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Department of Public Health, Texas A&M Health Science Center School of Public Health, College Station, Texas.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Dave
authors.affiliation: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Department of Internal Medicine/Cardiology, Mount Sinai St Luke's Roosevelt, New York, New York.
authors.forename: Ankit
authors.initials: A
authors.lastname: Chothani
authors.affiliation: Department of Internal Medicine, MacNeal Hospital, Berwyn, Illinois.
authors.forename: Jay
authors.initials: J
authors.lastname: Patel
authors.affiliation: Department of Cardiology, Citrus Memorial Hospital, Inverness, Florida.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ansari
authors.affiliation: Department of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio.
authors.forename: Ronak
authors.initials: R
authors.lastname: Bhimani
authors.affiliation: Department of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Cindy
authors.initials: C
authors.lastname: Grines
authors.affiliation: Department of Cardiology, Yale School of Medicine, New Heaven, Connecticut.
authors.forename: Michael
authors.initials: M
authors.lastname: Cleman
authors.affiliation: Department of Cardiology, Yale School of Medicine, New Heaven, Connecticut.
authors.forename: Abeel
authors.initials: A
authors.lastname: Mangi
authors.affiliation: Department of Cardiology, Yale School of Medicine, New Heaven, Connecticut.
authors.forename: John K
authors.initials: JK
authors.lastname: Forrest
authors.affiliation: Interventional Cardiology Division, The Everett Clinic, Everett, Washington. Electronic address: apurva_badheka@yahoo.com.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
mesh_terms: D000328:Adult; D017130:Angioplasty / Q000191:economics; D001017:Aortic Coarctation / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects / Q000191:economics; D016896:Treatment Outcome; D014481:United States