title: Daily cardiac catheterization procedural volume and complications at an academic medical center.
abstract: BACKGROUND
  Over 1,000,000 cardiac catheterizations (CC) are performed annually in the United States. There is a small risk of complication that has persisted despite advances in technology. It is unknown whether daily CC procedural volume can influence this risk. In an effort to improve outcomes at our academic medical center, we investigated the relationship between daily CC volume and complication rates.
  
  
  METHODS
  We obtained data from both the National Cardiovascular Data Registry (NCDR) Cath-PCI and Lumedx© databases reviewing the records of patients undergoing scheduled, non-emergent CC at our facility between January 2005 to June 2013. Daily CC volume was analyzed as were complications including death, post-procedure MI, cardiogenic shock, heart failure, stroke, tamponade, bleeding, hematoma and acute kidney injury (AKI).
  
  
  RESULTS
  12,773 patients were identified who underwent 16,612 CCs on 2,118 days. The average age was 63 years (SD 12.4; range, 18-95). 61% were men. A total of 326 complications occurred in 243 patients on 233 separate days (2.0% CC complication rate). The average volume per day was 7.8 CCs. We found a low correlation between daily complications and CC volume (Spearman's rho =0.11; P<0.01) though complication rates were lowest on days with 6-11 procedures; higher rates were found on slower and busier days.
  
  
  CONCLUSIONS
  We observed a U-shaped association between CC volume and rates of CC complications. The lowest complication rates were found on days with 6-11 procedures a day. The highest complication rate was seen with >11 procedures a day.
authors.affiliation: Baylor Scott & White Health, Temple, TX, USA; ; Texas A&M Health Science Center, Temple, TX, USA.
authors.forename: Kipp
authors.initials: K
authors.lastname: Slicker
authors.affiliation: Baylor Scott & White Health, Temple, TX, USA; ; Texas A&M Health Science Center, Temple, TX, USA.
authors.forename: Wesley G
authors.initials: WG
authors.lastname: Lane
authors.affiliation: Baylor Scott & White Health, Temple, TX, USA; ; Texas A&M Health Science Center, Temple, TX, USA.
authors.forename: Ola O
authors.initials: OO
authors.lastname: Oyetayo
authors.affiliation: Baylor Scott & White Health, Temple, TX, USA; ; Texas A&M Health Science Center, Temple, TX, USA; ; Central Texas Veterans Health Care System, Temple, TX, USA.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Copeland
authors.affiliation: Baylor Scott & White Health, Temple, TX, USA; ; Texas A&M Health Science Center, Temple, TX, USA.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Stock
authors.affiliation: Baylor Scott & White Health, Temple, TX, USA; ; Texas A&M Health Science Center, Temple, TX, USA.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Michel
authors.affiliation: Baylor Scott & White Health, Temple, TX, USA; ; Texas A&M Health Science Center, Temple, TX, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Erwin
keywords: ambulatory care; cardiac catheterization (CC); health facility size; risk factors