Hospital procedural volume and outcomes with catheter-directed intervention for pulmonary embolism: a nationwide analysis

Eur Heart J Acute Cardiovasc Care. 2022 Sep 29;11(9):684-692. doi: 10.1093/ehjacc/zuac082.

Abstract

Aims: There is limited data on the association between hospital catheter-directed intervention (CDI) volume and outcomes among patients with acute pulmonary embolism (PE).

Methods and results: The Nationwide Readmissions Database years 2016-2019 was utilized to identify hospitalizations undergoing CDI for acute PE. Hospitals were divided into tertiles based on annual CDI volume; low-volume (1-3 procedures), moderate-volume (4-12 procedures) and high-volume (>12 procedures). The primary outcome was all-cause in-hospital mortality. Among 1 436 382 PE admissions, 2.6% underwent CDI; 5.6% were in low-volume, 17.3% in moderate-volume and 77.1% in high-volume hospitals. There was an inverse relationship between hospital CDI volume and in-hospital mortality (coefficient -0.344, P < 0.001). On multivariable regression analysis, hospitals with high CDI volume were associated with lower in-hospital mortality compared with hospitals with low CDI volume (adjusted odds ratio [OR] 0.71; 95% confidence interval [CI] 0.53, 0.95). Additionally, there was an inverse association between CDI volume and length of stay (LOS) (regression coefficient -0.023, 95% CI -0.027, -0.019) and cost (regression coefficient -74.6, 95% CI -98.8, -50.3). There were no differences in major bleeding and 30-day unplanned readmission rates between the three groups.

Conclusion: In this contemporary observational analysis of PE admissions undergoing CDI, there was an inverse association between hospital CDI volume and in-hospital mortality, LOS, and cost. Major bleeding and 30-day unplanned readmission rates were similar between the three groups.

Keywords: Catheter-directed intervention; Procedure volume; Pulmonary embolism.

Publication types

  • Observational Study

MeSH terms

  • Acute Disease
  • Catheters
  • Hemorrhage
  • Hospital Mortality
  • Hospitals
  • Humans
  • Patient Readmission
  • Pulmonary Embolism* / epidemiology
  • Pulmonary Embolism* / therapy
  • Retrospective Studies