Key result
Higher hospital TMVR volume is linked to ~81% fewer in-hospital deaths and complications.
Why the study?
There is a lack of data on how hospital volumes affect outcomes of transcatheter mitral valve repair (TMVR).
Does higher hospital volume reduce in-hospital mortality and peri-procedural complications in patients undergoing transcatheter mitral valve repair?
Cross-Sectional (n=475)
Yes
Does higher hospital volume reduce in-hospital mortality and peri-procedural complications in patients undergoing transcatheter mitral valve repair?
Absolute Event Rate: 9.1% vs 48.7%
Higher hospital volumes for transcatheter mitral valve repair are associated with significantly lower in-hospital mortality and peri-procedural complications.
Supports volume-based TMVR referral; leaves open causality and optimal thresholds.
BACKGROUND: Transcatheter mitral valve repair (TMVR) is a complex procedure for patients with mitral regurgitation who cannot get surgery. However, there is a lack of data on how hospital volumes affect these outcomes. METHODS: We performed a cross sectional study based on Healthcare Cost and Utilization Project's Nationwide Inpatient Sample database of 2012 and identified subjects using the ICD-9-CM procedure code of 35.97, which was introduced in October 2010 for percutaneous mitral valve repair if present in the primary or secondary procedure field. Hospital volumes were divided into tertiles. The primary outcome was a composite of in-hospital mortality and peri-procedural complications. Length of stay and hospitalization cost were also assessed. RESULTS: A total of 95 (weighted n = 475) TMVR procedures were identified. The mean age of the overall cohort was 70 years; 43.2% were female and 63.2% had a significant baseline burden of co-morbidities. The composite of in-hospital mortality and peri-procedural complications decreased with increasing TMVR hospital volume: 48.7% in the first tertile, 17.4% in the second tertile, and 9.1% in the third tertile. Additionally, we saw a decrease in the length of stay and a trend in decrease in the hospitalization cost. CONCLUSION: In hospitals performing TMVR, higher hospital volumes are associated with a reduction in a composite of in-hospital mortality and post-procedural complications, in addition to the shorter length of stay.
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Patel et al. (2015) conducted a cross-sectional in Mitral regurgitation (n=475). Higher hospital volume vs. Lower hospital volume was evaluated on Composite of in-hospital mortality and peri-procedural complications. Higher hospital volume for transcatheter mitral valve repair was associated with a lower rate of in-hospital mortality and peri-procedural complications (9.1% in highest vs 48.7% in lowest tertile).
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