DOI: 10.1161/CIRCEP.114.001413
Utilization and Adverse Outcomes of Percutaneous Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation in the United States: Influence of Hospital Volume
Running title: Badheka et al.; Hospital Volume and LAA Closure Outcomes
Apurva O. Badheka, MD1*; Ankit Chothani, MD2*; Kathan Mehta, MD3*; Nileshkumar J. Patel, MD4*; Abhishek Deshmukh, MD5; Michael Hoosien, MD6; Neeraj Shah, MD4; Vikass Si S Singh, n pall S S.. Pa Panaich, Pana naic na ichh, MD1; Ankit ic MD6; Peeyush Grover, MD6; Ghanshyambhai T. Savani, MD6; Sidakpal Rathod, MD7; Nilay Patel, MD1; Shilpkumar Arora, MD1; Vipulkumar ar Bhalara, Bha haala lara ra,, MD1; James ra J m O. Ja Coffey,, MD6; William Will Wi lliam m O'Neill, MD8; Raj Makkar, Makkkar,, MD7; Cindy Cinddy L. Grines, Grines, MD1; Theodore Theodoo Schreiber, ber, MD1; Luigi be Luig gi Dii B Biase, iase ia se,, MD D9; Andrea A drrea Natale, An Natalee, MD M 9; Ju Juan uan F F.. Vi V Viles-Gonzalez, les-Go G nzal Go allezz, M MD6 1
Detroid Medical Medi dica di c l Ce ca C Center, nter nt er, De Detr Detroit, trroi oit, t, M MI; I 2Me I; MedStar M dSta dS tarr Wa ta W Washington shhin i gt gton on H Hospital ospi os pita pi tall Ce Cent Center, nter er, Wa er W Washington, ash shin sh ing ngton gton, n, DC DC;; 3UP UPMC P 4 5 Staten Stat a en n IIsland slan sl andd Un an University niv iver ersi er siity H Hospital, osspi pita taal, S Staten taate tenn Is Isla Island, land la n , NY nd NY; Y; Un University niv versitt of Shadysidee Hospital, Pittsburgh, Hoosppit ital al,, Pi al Pitt ttsb tt sbburrg sbur gh, PA PA;; St a Li as, as Litt ttle tt le R ock oc k, A R; 6Un Arkansas, Little Rock, AR; University Univ iver iv ersi er sity si ty of of Miami Miam Mi amii Miller am Mill Mi ller ll er S School choo ch ooll of M oo Medicine, edic ed icin ic inee, M in Miami, iami ia mi, FL mi FL;; 7Ce Cedar-Sinai Ceda darr-Si da Sii 8 9 Henry Henr n y Ford nr F rd Hospital, Fo Hosp Ho sppittal a , Detroit, Detr De troi tr oitt, MI; oi MI; I Texa Texas Te exa xass Cardiac Card Ca rdia rd iac ac Arrhythmia Arr r hy h th thmi miaa Institute, mi Inst In stitute, Austin, st Austt TX Medical Center, n nter, LA, CA CA;; He *contributed equally
Correspondence: Juan F. Viles-Gonzalez, MD University of Miami Hospital 1400 NW 12th Ave, Suite 4062 Miami, FL 33136. Tel: (305) 243-5070 Fax: (305)243-5565 E-mail: [email protected].
Journal Subject Codes: [23] Catheter-based coronary and valvular interventions:other, [5] Arrhythmias, clinical electrophysiology, drugs, [64] Primary and secondary stroke prevention
1 Downloaded from http://circep.ahajournals.org/ at New York University/ Medical Center--New York on May 20, 2015
DOI: 10.1161/CIRCEP.114.001413
Abstract: Background - Safety data on percutaneous left atrial appendage (LAA) closure arises from centers with considerable expertise in the procedure or from clinical trial, which might not be reproducible in clinical practice. We sought to estimate the frequency and predictors of adverse outcomes and costs of percutaneous LAA closure procedure in the US. Methods and Results - The data was obtained from the Nationwide Inpatient Sample (NIS) from the years 2006-2010. The NIS is the largest all-payer inpatient dataset in the US. Complications were calculated using patient safety indicators (PSI) and ICD-9-CM codes. Annual hospital volume was calculated using unique hospital identifiers. Weights provided by y the NIS were used to generate national estimates. A total of 268 (weighted=1,288) procedures analyzed. dur ures es were wer eree an anal alyyzed al yzed ed. The overall composite rate of mortality or any adverse event was 24.3% (65), with patients 5), wi ith 33.4% .4% .4 % pa pati tien ti ent required open penn cardiac card ca r ia rd iacc su surgery urg rgery post procedure. Average Aveerage LOS was 4.611 ± 1.05 days and cost of care was 26,024 34,651. Annual significantly associated 6, 24 ± 34,65 6,02 51. An nnu nual al hhospital ospi pita pi t l procedural ta proccedurral vvolume olum ol me wa was si sign g ific gn icaantl ic tlyy as tl asso soci so c at ci a ed e with reduced complications and mortality 0.89, CII 0.85 0.85-0.94, m li mpli mp l cationns an nd mo m ortaliity (every ( ve (e very y uunit niit increase: incrrease see: OR se: R 0.89 9, 95% 5% C 85-0.994, p
Utilization and Adverse Outcomes of Percutaneous Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation in the United States: Influence of Hospital Volume
Running title: Badheka et al.; Hospital Volume and LAA Closure Outcomes
Apurva O. Badheka, MD1*; Ankit Chothani, MD2*; Kathan Mehta, MD3*; Nileshkumar J. Patel, MD4*; Abhishek Deshmukh, MD5; Michael Hoosien, MD6; Neeraj Shah, MD4; Vikass Si S Singh, n pall S S.. Pa Panaich, Pana naic na ichh, MD1; Ankit ic MD6; Peeyush Grover, MD6; Ghanshyambhai T. Savani, MD6; Sidakpal Rathod, MD7; Nilay Patel, MD1; Shilpkumar Arora, MD1; Vipulkumar ar Bhalara, Bha haala lara ra,, MD1; James ra J m O. Ja Coffey,, MD6; William Will Wi lliam m O'Neill, MD8; Raj Makkar, Makkkar,, MD7; Cindy Cinddy L. Grines, Grines, MD1; Theodore Theodoo Schreiber, ber, MD1; Luigi be Luig gi Dii B Biase, iase ia se,, MD D9; Andrea A drrea Natale, An Natalee, MD M 9; Ju Juan uan F F.. Vi V Viles-Gonzalez, les-Go G nzal Go allezz, M MD6 1
Detroid Medical Medi dica di c l Ce ca C Center, nter nt er, De Detr Detroit, trroi oit, t, M MI; I 2Me I; MedStar M dSta dS tarr Wa ta W Washington shhin i gt gton on H Hospital ospi os pita pi tall Ce Cent Center, nter er, Wa er W Washington, ash shin sh ing ngton gton, n, DC DC;; 3UP UPMC P 4 5 Staten Stat a en n IIsland slan sl andd Un an University niv iver ersi er siity H Hospital, osspi pita taal, S Staten taate tenn Is Isla Island, land la n , NY nd NY; Y; Un University niv versitt of Shadysidee Hospital, Pittsburgh, Hoosppit ital al,, Pi al Pitt ttsb tt sbburrg sbur gh, PA PA;; St a Li as, as Litt ttle tt le R ock oc k, A R; 6Un Arkansas, Little Rock, AR; University Univ iver iv ersi er sity si ty of of Miami Miam Mi amii Miller am Mill Mi ller ll er S School choo ch ooll of M oo Medicine, edic ed icin ic inee, M in Miami, iami ia mi, FL mi FL;; 7Ce Cedar-Sinai Ceda darr-Si da Sii 8 9 Henry Henr n y Ford nr F rd Hospital, Fo Hosp Ho sppittal a , Detroit, Detr De troi tr oitt, MI; oi MI; I Texa Texas Te exa xass Cardiac Card Ca rdia rd iac ac Arrhythmia Arr r hy h th thmi miaa Institute, mi Inst In stitute, Austin, st Austt TX Medical Center, n nter, LA, CA CA;; He *contributed equally
Correspondence: Juan F. Viles-Gonzalez, MD University of Miami Hospital 1400 NW 12th Ave, Suite 4062 Miami, FL 33136. Tel: (305) 243-5070 Fax: (305)243-5565 E-mail: [email protected].
Journal Subject Codes: [23] Catheter-based coronary and valvular interventions:other, [5] Arrhythmias, clinical electrophysiology, drugs, [64] Primary and secondary stroke prevention
1 Downloaded from http://circep.ahajournals.org/ at New York University/ Medical Center--New York on May 20, 2015
DOI: 10.1161/CIRCEP.114.001413
Abstract: Background - Safety data on percutaneous left atrial appendage (LAA) closure arises from centers with considerable expertise in the procedure or from clinical trial, which might not be reproducible in clinical practice. We sought to estimate the frequency and predictors of adverse outcomes and costs of percutaneous LAA closure procedure in the US. Methods and Results - The data was obtained from the Nationwide Inpatient Sample (NIS) from the years 2006-2010. The NIS is the largest all-payer inpatient dataset in the US. Complications were calculated using patient safety indicators (PSI) and ICD-9-CM codes. Annual hospital volume was calculated using unique hospital identifiers. Weights provided by y the NIS were used to generate national estimates. A total of 268 (weighted=1,288) procedures analyzed. dur ures es were wer eree an anal alyyzed al yzed ed. The overall composite rate of mortality or any adverse event was 24.3% (65), with patients 5), wi ith 33.4% .4% .4 % pa pati tien ti ent required open penn cardiac card ca r ia rd iacc su surgery urg rgery post procedure. Average Aveerage LOS was 4.611 ± 1.05 days and cost of care was 26,024 34,651. Annual significantly associated 6, 24 ± 34,65 6,02 51. An nnu nual al hhospital ospi pita pi t l procedural ta proccedurral vvolume olum ol me wa was si sign g ific gn icaantl ic tlyy as tl asso soci so c at ci a ed e with reduced complications and mortality 0.89, CII 0.85 0.85-0.94, m li mpli mp l cationns an nd mo m ortaliity (every ( ve (e very y uunit niit increase: incrrease see: OR se: R 0.89 9, 95% 5% C 85-0.994, p
