Key result
Higher annual hospital volume was associated with a higher utilization rate of multivessel percutaneous coronary intervention (OR 1.34; 95% CI 1.16-1.54; P<0.001).
Why the study?
What are the predictors and hospital-level variations in the utilization of multivessel percutaneous coronary intervention in the USA?
Observational (n=543,434)
Yes
What are the predictors and hospital-level variations in the utilization of multivessel percutaneous coronary intervention in the USA?
Odds Ratio: 1.34 (95% CI 1.16–1.54)
p-value: p=<0.001
There is considerable hospital-level variation in the utilization of multivessel PCI in the USA, with higher annual hospital volume associated with higher utilization rates.
Higher-volume hospitals show greater multivessel PCI use; observational data leave open appropriateness and outcome impact.
BACKGROUND: The purpose of this study was to investigate the contemporary trends in the utilization of multivessel percutaneous coronary interventions (MVPCIs) in the USA. METHODS: We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample between 2006 and 2011 using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes 00.40 (single stent), 00.46, 00.47, and 00.48 (single vessel and multiple stents) and 00.41, 00.42 and 00.43 (MVPCI). We built a hierarchical three-level model adjusted for multiple confounding factors. RESULTS: A total of 543 434 (weighted: 2 683 206) procedures were identified. Independent predictors of increased MVPCI utilization (odds ratio, 95% confidence interval, P-value) were found to be age (1.05, 1.04-1.07, P<0.001) and comorbid conditions on using Deyo's modification of Charlson's comorbidity index of at least 2 (1.13, 1.09-1.16, P<0.001). Female sex (0.88, 0.87-0.90, P<0.001), myocardial infarction (0.86, 0.83-0.89, P<0.001), weekend admissions (0.94, 0.91-0.96, P<0.001), and urgent admissions (0.88, 0.83-0.93, P<0.001) predicted decreased utilization. Highest quartile of hospital (1.34, 1.16-1.54, P<0.001) predicted higher utilization. Between-hospital variation of 7.7% (interclass correlation coefficient) was observed, which was minimally affected by patient or hospital mix. A randomly selected patient was ∼1.6 (median odds ratio) times more likely to receive an MVPCI from a given hospital compared with another identical patient being treated at a different random hospital. CONCLUSION: The utilization rate of MVPCI varied considerably among hospitals. Higher annual hospital volume was associated with a higher utilization rate of MVPCI.
No takes yet. Share an insight, caveat, or question.
Patel et al. (2015) conducted an observational in Percutaneous coronary intervention (n=543,434). Highest quartile of hospital volume vs. Lower hospital volume was evaluated on Utilization of multivessel percutaneous coronary intervention (OR 1.34, 95% CI 1.16-1.54, p=<0.001). Higher annual hospital volume was associated with a higher utilization rate of multivessel percutaneous coronary intervention (OR 1.34; 95% CI 1.16-1.54; P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: