Impact of hospital volume on outcomes of percutaneous ASD/PFO closure in pediatric patients

Authors

• Parth Bhatt, Texas Tech University Health Sciences Center, Amarillo, TX, USA.
• Achint Patel, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
• Varun Kumar, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, NY, USA.
• Anusha Lekshminarayanan, Mercy Health, Cincinnati, OH, USA.
• Viranchi Patel, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
• Srilatha Alapati, Texas Tech University Health Sciences Center, Amarillo, TX, USA.
• Zeenia Cyrus Billimoria, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA. zeenia.billimoria@seattlechildrens.org.

Document Type

Article

Abstract

BACKGROUND: We investigated the effect of hospital volume on percutaneous closure of atrial septal defect/patent foramen ovale (ASD) among pediatric patients. METHODS: We identified patients undergoing percutaneous closure of ASD with device using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure code 35.52 from the National Inpatient Sample, years 2002-2011. Patients with age ≤ 18 years and primary diagnosis code 745.5 for ASD were included. Hospital volume was calculated using unique identification numbers and divided into tertiles for analysis. Multivariate regression analysis was performed to determine independent predictors of procedure-related complications which were coded using specific codes released by Healthcare Cost and Utilization Project. RESULTS: 6162 percutaneous ASD closure procedures were analyzed. There was no mortality associated with percutaneous ASD closure. Cardiac complications (9.5%) were most common. On multivariate analysis, age increment of 3 years decreased the odds of developing complications (OR 0.83, 95% CI 0.79-0.87, P < 0.001). Odds of developing complications in the 2nd (OR 0.74, 95% CI 0.62-0.89, P = 0.007) and 3rd tertiles (OR 0.34, 95% CI 0.27-0.42, P < 0.001) were lower as compared to the 1st tertile of hospital volume. CONCLUSION: Increasing annual hospital volume is an independent predictor of lower complication rates in percutaneous ASD closure cases with no associated mortality in pediatric patients.

Medical Subject Headings

Cardiac Catheterization (methods); Cardiac Surgical Procedures (adverse effects, methods); Child; Child, Preschool; Cohort Studies; Databases, Factual; Female; Follow-Up Studies; Foramen Ovale, Patent (diagnostic imaging, surgery); Heart Septal Defects, Atrial (diagnostic imaging, surgery); Hospitals, High-Volume; Humans; Infant; Infant, Newborn; Logistic Models; Male; Minimally Invasive Surgical Procedures (adverse effects, methods); Multivariate Analysis; Postoperative Complications (epidemiology, physiopathology); Retrospective Studies; Risk Assessment; Treatment Outcome; United States

Publication Date

8-1-2018

Publication Title

World journal of pediatrics : WJP

E-ISSN

1867-0687

Volume

14

Issue

4

First Page

364

Last Page

372

PubMed ID

29508364

Digital Object Identifier (DOI)

10.1007/s12519-018-0120-3

Recommended Citation

Bhatt, Parth; Patel, Achint; Kumar, Varun; Lekshminarayanan, Anusha; Patel, Viranchi; Alapati, Srilatha; and Billimoria, Zeenia Cyrus, "Impact of hospital volume on outcomes of percutaneous ASD/PFO closure in pediatric patients" (2018). Neurology. 2076.
https://scholar.barrowneuro.org/neurology/2076