Association of Hospital Procedural Volume With Outcomes of Left Ventricular Assist Device Placement

SHAZIB SAGHEER, ABDUL MANNAN KHAN MINHAS, SYEDA HUMNA ZAIDI, ISHAN SHAH, KEERAT RAI AHUJA, SATISH KUMAR AHUJA, SALIK NAZIR, KHAWAJA M. TALHA, SOURBHA S. DANI, MARAT FUDIM, DMITRY ABRAMOV, SALIM S. VIRANI, NAJAM WASTY

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: With the advancement in device technology, the use of durable left ventricular assist devices (LVADs) has increased significantly in recent years. However, there is a dearth of evidence to conclude whether patients who undergo LVAD implantation at high-volume centers have better clinical outcomes than those receiving care at low- or medium-volume centers. Methods: We analyzed the hospitalizations using the Nationwide Readmission Database for the year 2019 for new LVAD implantation. Baseline comorbidities and hospital characteristics were compared among low- (1–5 procedures/year), medium- (6–16 procedures/year) and high-volume (17–72 procedures/year) hospitals. The volume/outcome relationship was analyzed using the annualized hospital volume as a categorical variable (tertiles) as well as a continuous variable. Multilevel mixed-effect logistic regression and negative binomial regression models were used to determine the association of hospital volume and outcomes, with tertile 1 (low-volume hospitals) as the reference category. Results: A total of 1533 new LVAD procedures were included in the analysis. The inpatient mortality rate was lower in the high-volume centers compared with the low-volume centers (9.04% vs 18.49%, aOR 0.41, CI0.21–0.80; P = 0.009). There was a trend toward lower mortality rates in medium-volume centers compared with low-volume centers; however, it did not reach statistical significance (13.27% vs 18.49%, aOR 0.57, CI0.27–1.23; P = 0.153). Similar results were seen for major adverse events (composite of stroke/transient ischemic attack and in-hospital mortality). There was no significant difference in bleeding/transfusion, acute kidney injury, vascular complications, pericardial effusion/hemopericardium/tamponade, length of stay, cost, or 30-day readmission rates between medium- and high-volume centers compared to low-volume centers. Conclusion: Our findings indicate lower inpatient mortality rates in high-volume LVAD implantation centers and a trend toward lower mortality rates in medium-volume LVAD implantation centers compared to lower-volume centers.

Original languageEnglish
Pages (from-to)1531-1538
Number of pages8
JournalJournal of Cardiac Failure
Volume29
Issue number11
DOIs
Publication statusPublished - Nov 2023

Keywords

  • LVAD
  • implantation
  • inpatient outcomes
  • volume

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