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Abstract
Objective We aimed to determine the relationship between the prevalence of in-hospital complications and annual institutional patient volume in a population of patients undergoing percutaneous coronary intervention (PCI).
Methods Clinical data of patients receiving PCI between January 2010 and June 2015 were collected from 14 academic institutions in the Tokyo area and subsequently used for analysis. We employed multivariate hierarchical logistic regression models to determine the effect of institutional volume on several in-hospital outcomes, including in-hospital mortality and procedure-related complications.
Results A total of 14 437 PCI cases were included and categorised as receiving intervention from either lower-volume (<200 procedures/year, n=6 hospitals) or higher-volume (≥200 procedures/year, n=8 hospitals) institutions. Clinical characteristics differed significantly between the two patient groups. Specifically, patients treated in higher-volume hospitals presented with increased comorbidities and complex coronary lesions. Unadjusted mortality and complication rate in lower-volume and higher-volume hospitals were 1.3% and 1.2% (p=0.0614) and 6.2% and 8.1% (p=0.001), respectively. However, multivariate hierarchical logistic regression models adjusting for differences in the patient characteristics demonstrated that institutional volume was not associated with adverse clinical outcomes.
Conclusions In conclusion, we observed no significant association between annual institutional volume and in-hospital outcomes within the contemporary PCI multicentre registry.
Trial registration number UMIN R000005598.
- coronary artery disease
- coronary intervention (pci)
- quality of care and outcomes
- hospital volume
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Footnotes
Contributors MK drafted of the manuscript and was involved in conception and design of the study, statistical calculations and analyses, and interpretation of data. SK was involved in conception and design of the study, and revised the manuscript critically for important intellectual content and provided final approval. TK, YN, TO, IN, IU and KF revised the manuscript critically for important intellectual content.
Funding This research was funded by a grant from the Ministry of Education, Culture, Sports, Science and Technology, Japan (KAKENHI No. 21790751, 16H05215, and 16KK0186).
Competing interests Dr. Kohsaka has received grants from Bayer Yakuhin and Daiichi-Sankyo; has received lecture fees from Bayer Yakuhin and Bristol-Myers Squibb.
Patient consent Obtained.
Ethics approval The study was approved by the institutional review board of Keio University School of Medicine. Before the launch of the registry, information on the objectives of the present study, its social significance and an abstract were provided for clinical trial registration with the University Hospital Medical Information Network. This Network is recognised by the International Committee of Medical Journal Editors as an ‘acceptable registry’, according to a statement issued in September 2004 (UMIN R000005598). The patient record was anonymised and deidentified prior to analysis. Major teaching hospitals within the metropolitan Tokyo area were selected for the pilot phase of this study, and the study protocol was approved by the institutional review board at each site. Patients were enrolled at the event; all the consecutive PCI procedures during study period, including failure cases, were registered.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.