Transfemoral TAVR performed at hospitals in the lowest-volume quartile was associated with higher 30-day mortality compared to the highest-volume quartile (3.19% vs 2.66%; OR 1.21, P=0.02).
Observational (n=113,662)
Yes
Does higher hospital procedural volume reduce 30-day mortality in patients undergoing transfemoral TAVR?
There is a significant inverse association between hospital procedural volume and 30-day mortality for transfemoral TAVR, supporting volume-based center requirements.
Effect estimate: OR 1.21
Absolute Event Rate: 3.19% vs 2.66%
p-value: p=0.02
BACKGROUND: During the introduction of transcatheter aortic-valve replacement (TAVR) in the United States, requirements regarding procedural volume were mandated by the Centers for Medicare and Medicaid Services as a condition of reimbursement. A better understanding of the relationship between hospital volume of TAVR procedures and patient outcomes could inform policy decisions. METHODS: We analyzed data from the Transcatheter Valve Therapy Registry regarding procedural volumes and outcomes from 2015 through 2017. The primary analyses examined the association between hospital procedural volume as a continuous variable and risk-adjusted mortality at 30 days after transfemoral TAVR. Secondary analysis included risk-adjusted mortality according to quartile of hospital procedural volume. A sensitivity analysis was performed after exclusion of the first 12 months of transfemoral TAVR procedures at each hospital. RESULTS: Of 113,662 TAVR procedures performed at 555 hospitals by 2960 operators, 96,256 (84.7%) involved a transfemoral approach. There was a significant inverse association between annualized volume of transfemoral TAVR procedures and mortality. Adjusted 30-day mortality was higher and more variable at hospitals in the lowest-volume quartile (3.19%; 95% confidence interval CI, 2.78 to 3.67) than at hospitals in the highest-volume quartile (2.66%; 95% CI, 2.48 to 2.85) (odds ratio, 1.21; P = 0.02). The difference in adjusted mortality between a mean annualized volume of 27 procedures in the lowest-volume quartile and 143 procedures in the highest-volume quartile was a relative reduction of 19.45% (95% CI, 8.63 to 30.26). After the exclusion of the first 12 months of TAVR procedures at each hospital, 30-day mortality remained higher in the lowest-volume quartile than in the highest-volume quartile (3.10% vs. 2.61%; odds ratio, 1.19; 95% CI, 1.01 to 1.40). CONCLUSIONS: An inverse volume-mortality association was observed for transfemoral TAVR procedures from 2015 through 2017. Mortality at 30 days was higher and more variable at hospitals with a low procedural volume than at hospitals with a high procedural volume. (Funded by the American College of Cardiology Foundation National Cardiovascular Data Registry and the Society of Thoracic Surgeons.).
Vemulapalli et al. (Wed,) conducted a observational in Aortic Stenosis undergoing TAVR (n=113,662). Lowest-volume quartile hospitals vs. Highest-volume quartile hospitals was evaluated on Risk-adjusted mortality at 30 days after transfemoral TAVR (OR 1.21, p=0.02). Transfemoral TAVR performed at hospitals in the lowest-volume quartile was associated with higher 30-day mortality compared to the highest-volume quartile (3.19% vs 2.66%; OR 1.21, P=0.02).