Effect of Center Volume on Outcomes in Hospitalized Patients With Hereditary Hemorrhagic Telangiectasia.
OBJECTIVE
To determine whether hospitalized patients with hereditary hemorrhagic telangiectasia (HHT) had better outcomes at high-volume treatment centers (HVCs).


METHODS
The Nationwide Inpatient Sample (2000-2011) was used to identify HHT-related hospitalizations. Hospitals were classified based on quartiles of annual HHT discharge volume. The 75th percentile cutoff value (third quartile) was used to classify hospitals as low-volume centers (1-7 HHT discharges per year) or as HVCs (≥8 discharges per year. Demographic features, complication rates, and outcomes were compared between the 2 groups.


RESULTS
We identified 9440 hospital discharges in patients with HHT. Of these patients, 6856 (72.6%) were admitted to low-volume centers and 2584 (27.4%) to HVCs. The former were more likely to be of white race, older, and with higher income levels (P<.001 for each). The HVCs had higher rates of anemia, epistaxis, congestive heart failure, pulmonary hypertension, and cerebral and pulmonary arteriovenous malformations and lower rates of ischemic stroke and myocardial infarction. After adjusting for baseline differences in a multivariate model, patients treated at HVCs were more likely to be discharged home (odds ratio [OR]=1.35; 95% CI, 1.21-1.52; P<.001) and less likely to be discharged to short-term rehabilitation facilities (OR=0.45; 95% CI, 0.31-0.64; P<.001). Patients treated at HVCs also had a significantly lower risk of in-hospital mortality (OR=0.51; 95% CI, 0.34-0.74; P<.001).


CONCLUSIONS
Patients with HHT hospitalized at HVCs had better outcomes, with lower in-hospital mortality and higher home discharge rates. These findings strongly support ongoing efforts to expand access to HHT centers of excellence in the United States and worldwide.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address: iyer.vivek@mayo.edu.
Vivek N
VN
Iyer
Department of Radiology, Mayo Clinic, Rochester, MN.
Waleed
W
Brinjikji
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Bibek S
BS
Pannu
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Dinesh R
DR
Apala
Department of Neurosurgery, Mayo Clinic, Rochester, MN.
Giuseppe
G
Lanzino
Department of Radiology, Mayo Clinic, Rochester, MN.
Harry J
HJ
Cloft
Department of Radiology, Mayo Clinic, Rochester, MN.
Sanjay
S
Misra
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Michael J
MJ
Krowka
Department of Radiology, Mayo Clinic, Rochester, MN.
Christopher P
CP
Wood
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Scottsdale, AZ.
Karen L
KL
Swanson
D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D011786:Quality Control; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000453:epidemiology / Q000628:therapy*; D014481:United States / Q000453:epidemiology