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Effect of center catheterization volume on risk of catastrophic adverse event after cardiac catheterization in children.

Abstract：

BACKGROUND:Procedural volume has been shown to be associated with outcome in cardiac catheterization and intervention in adults. The impact of center-level factors (such as volume) and their interaction with subject- and procedure-level factors on outcome after cardiac catheterization in children is not well described. We hypothesized that higher center catheterization volume would be associated with lower risk of catastrophic adverse events. METHODS:We studied children and young adults 0 to 21 years of age undergoing one or more cardiac catheterizations at centers participating in the Pediatric Health Information Systems database between 2007 and 2012. Using mixed-effects multivariable regression, we assessed the association between center catheterization volumes and the risk of a composite outcome of death and/or initiation of mechanical circulatory support within 1 day of cardiac catheterization adjusting for patient- and procedure-level factors. RESULTS:A total of 63,994 procedures performed on 40,612 individuals from 38 of 43 centers contributing data to the Pediatric Health Information Systems database were included. The adjusted risk of the composite outcome was 0.1%. Increasing annual catheterization laboratory volume was independently associated with reduced risk of the composite outcome (odds ratio per a 100-procedure/y increment 0.78 [95% CI 0.65-0.93], P < .006). Younger age at catheterization, previous cardiac operation in the same admission as the catheterization, preprocedural vasoactive medications, and hemodialysis were also independently associated with an increased risk of adverse outcomes. CONCLUSIONS:Higher cardiac catheterization laboratory volume was associated with reduced risk of catastrophic adverse outcome in the immediate postcatheterization period in children. The observed benefit of catheterization at a larger volume center may be attributable to transmissible best practices or inextricable benefits of larger systems.

journal_name

Am Heart J

journal_title

American heart journal

authors

O'Byrne ML,Glatz AC,Shinohara RT,Jayaram N,Gillespie MJ,Dori Y,Rome JJ,Kawut S

doi

10.1016/j.ahj.2015.02.018

subject

Has Abstract

pub_date

2015-06-01 00:00:00

pages

823-832.e5

issue

eissn

0002-8703

issn

1097-6744

pii

S0002-8703(15)00122-2

journal_volume

169

pub_type

杂志文章,多中心研究

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Effect of center catheterization volume on risk of catastrophic adverse event after cardiac catheterization in children.