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Hospital volume of throughput and periprocedural and medium-term adverse events after percutaneous coronary intervention: retrospective cohort study of all 17 417 procedures undertaken in Scotland, 1997–2003
  1. K R Burton1,
  2. R Slack2,
  3. K G Oldroyd3,
  4. A C H Pell4,
  5. A D Flapan5,
  6. I R Starkey6,
  7. H Eteiba7,
  8. K P Jennings8,
  9. R J Northcote9,
  10. W Stewart Hillis3,
  11. J P Pell10
  1. 1Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
  2. 2Department of Public Health, Greater Glasgow NHS Board, Glasgow, UK
  3. 3Department of Cardiology, Western Infirmary, Glasgow, UK
  4. 4Department of Cardiology, Monklands Hospital, Airdrie, UK
  5. 5Department of Cardiology, Royal Infirmary, Edinburgh, UK
  6. 6Department of Cardiology, Western General Hospital, Edinburgh, UK
  7. 7Department of Cardiology, Glasgow Royal Infirmary, Glasgow, UK
  8. 8Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
  9. 9Department of Cardiology, Victoria Infirmary, Glasgow, UK
  10. 10BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
  1. Correspondence to:
    Professor Jill Pell
    Room C214, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK; j.pell{at}clinmed.gla.ac.uk

Abstract

Objective: To determine whether percutaneous coronary intervention (PCI) hospital volume of throughput is associated with periprocedural and medium-term events, and whether any associations are independent of differences in case mix.

Design: Retrospective cohort study of all PCIs undertaken in Scottish National Health Service hospitals over a six-year period.

Methods: All PCIs in Scotland during 1997–2003 were examined. Linkage to administrative databases identified events over two years’ follow up. The risk of events by hospital volume at 30 days and two years was compared by using logistic regression and Cox proportional hazards models.

Results: Of the 17 417 PCIs, 4900 (28%) were in low-volume hospitals and 3242 (19%) in high-volume hospitals. After adjustment for case mix, there were no significant differences in risk of death or myocardial infarction. Patients treated in high-volume hospitals were less likely to require emergency surgery (adjusted odds ratio 0.18, 95% confidence interval (CI) 0.07 to 0.54, p  =  0.002). Over two years, patients in high-volume hospitals were less likely to undergo surgery (adjusted hazard ratio 0.52, 95% CI 0.35 to 0.75, p  =  0.001), but this was offset by an increased likelihood of further PCI. There was no net difference in coronary revascularisation or in overall events.

Conclusion: Death and myocardial infarction were infrequent complications of PCI and did not differ significantly by volume. Emergency surgery was less common in high-volume hospitals. Over two years, patients treated in high-volume centres were as likely to undergo some form of revascularisation but less likely to undergo surgery.

  • CABG, coronary artery bypass grafting
  • HR, hazard ratio
  • OR, odds ratio
  • PCI, percutaneous coronary intervention
  • SMR, Scottish Morbidity Record

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Footnotes

  • Published Online First 18 May 2006

  • Funding: Scottish Executive

  • Competing interests: None declared.

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