Higher procedural volume linked to better outcomes for LAAO

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Higher procedural volume is associated with better outcomes for percutaneous left atrial appendage occlusion (LAAO) procedures, research published online in JACC: Cardiovascular Interventions has found.

Outlining the rationale for the study, lead author Salik Nazir (University of Toledo Medical Center, Toledo and Cleveland Clinic, Cleveland, USA) writes that several studies have demonstrated an inverse volume-outcome relationship for patients undergoing invasive cardiac procedures, although the existence of a similar association for LAAO remains unknown.

To test whether such an association can be established, Nazir and colleagues used records from the Nationwide Readmissions Database of patients who underwent LAAO in 2017. The study team categorised hospitals into three groups on the basis of tertiles of annual procedural volume: low (five to 15 cases/year), medium (17 to 31 cases/year), and high (32 to 211 cases/year).

Multivariate hierarchical logistic regression and restricted cubic spline analyses were performed to examine the association of hospital LAAO volume and outcomes. The primary outcome was in-hospital major adverse events (MAE), defined as a composite of mortality, stroke or transient ischaemic attack, bleeding or transfusion, vascular complications, myocardial infarction, systemic embolization, and pericardial effusion or tamponade requiring pericardiocentesis or surgery.

The study included 5,949 LAAO procedures performed across 196 hospitals with a median annual procedural volume of 41 (interquartile range: 25 to 67).

Nazir et al report that low-volume hospitals had higher rates of in-hospital MAE (9.5% vs. 5.6%; p< 0.001), stroke or transient ischaemic attack (2.1% vs. 1.3%; p=0.049), and bleeding or transfusion (6.1% vs. 3.5%; p=0.002) compared with high-volume hospitals. No differences were noted for other components of MAE and index length of stay.

On multivariate analysis, higher procedural volume was associated with lower rates of in-hospital MAE, with an adjusted odds ratio for medium versus low volume of 0.69 (95% confidence interval: 0.46 to 1.04; p=0.08) and for high versus low volume of 0.55 (95% confidence interval: 0.37 to 0.82; p=0.003).

These findings led Nazir and colleagues to conclude that higher hospital procedural volume is associated with better outcomes for LAAO procedures. “Further studies are needed to determine if this relationship persists for long-term outcomes,” they add.


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