title: Influence of hospital volume and outcomes of adult structural heart procedures.
abstract: Hospital volume is regarded amongst many in the medical community as an important quality metric. This is especially true in more complicated and less commonly performed procedures such as structural heart disease interventions. Seminal work on hospital volume relationships was done by Luft et al more than 4 decades ago, when they demonstrated that hospitals performing > 200 surgical procedures a year had 25%-41% lower mortality than those performing fewer procedures. Numerous volume-outcome studies have since been done for varied surgical procedures. An old adage "practice makes perfect" indicating superior operator and institutional experience at higher volume hospitals is believed to primarily contribute to the volume outcome relationship. Compelling evidence from a slew of recent publications has also highlighted the role of hospital volume in predicting superior post-procedural outcomes following structural heart disease interventions. These included transcatheter aortic valve repair, transcatheter mitral valve repair, septal ablation and septal myectomy for hypertrophic obstructive cardiomyopathy, left atrial appendage closure and atrial septal defect/patent foramen ovale closure. This is especially important since these structural heart interventions are relatively complex with evolving technology and a steep learning curve. The benefit was demonstrated both in lower mortality and complications as well as better economics in terms of lower length of stay and hospitalization costs seen at high volume centers. We present an overview of the available literature that underscores the importance of hospital volume in complex structural heart disease interventions.
authors.affiliation: Sidakpal S Panaich, Interventional Cardiology, Borgess Medical Center, Kalamazoo, MI 49048, United States.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.affiliation: Sidakpal S Panaich, Interventional Cardiology, Borgess Medical Center, Kalamazoo, MI 49048, United States.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: Sidakpal S Panaich, Interventional Cardiology, Borgess Medical Center, Kalamazoo, MI 49048, United States.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Sidakpal S Panaich, Interventional Cardiology, Borgess Medical Center, Kalamazoo, MI 49048, United States.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Sidakpal S Panaich, Interventional Cardiology, Borgess Medical Center, Kalamazoo, MI 49048, United States.
authors.forename: Samir V
authors.initials: SV
authors.lastname: Patel
authors.affiliation: Sidakpal S Panaich, Interventional Cardiology, Borgess Medical Center, Kalamazoo, MI 49048, United States.
authors.forename: Chirag
authors.initials: C
authors.lastname: Savani
authors.affiliation: Sidakpal S Panaich, Interventional Cardiology, Borgess Medical Center, Kalamazoo, MI 49048, United States.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Sidakpal S Panaich, Interventional Cardiology, Borgess Medical Center, Kalamazoo, MI 49048, United States.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sonani
authors.affiliation: Sidakpal S Panaich, Interventional Cardiology, Borgess Medical Center, Kalamazoo, MI 49048, United States.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Sidakpal S Panaich, Interventional Cardiology, Borgess Medical Center, Kalamazoo, MI 49048, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Cleman
authors.affiliation: Sidakpal S Panaich, Interventional Cardiology, Borgess Medical Center, Kalamazoo, MI 49048, United States.
authors.forename: Abeel
authors.initials: A
authors.lastname: Mangi
authors.affiliation: Sidakpal S Panaich, Interventional Cardiology, Borgess Medical Center, Kalamazoo, MI 49048, United States.
authors.forename: John K
authors.initials: JK
authors.lastname: Forrest
authors.affiliation: Sidakpal S Panaich, Interventional Cardiology, Borgess Medical Center, Kalamazoo, MI 49048, United States.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
keywords: Hospital volume; Left atrial appendage closure; Septal ablation; Septal myectomy; Transcatheter aortic valve repair; Transcatheter mitral valve repair