Angioplasty volume is not that important
Institutions performing low volumes of angioplasties can still have excellent outcomes, according to a new study from Rush-Presbyterian-St. Luke’s Medical Center in Chicago.1 The study found that even though yearly individual operator volumes ranged from 26 to 83 cases lower than the 75 cases currently recommended by the American College of Cardiology and the American Heart Association the in-hospital major complication rate was just 1.4%. The study compared that rate to previously published registries such as the 1992-93 Society for Cardiac Angiography and Intervention Registry, which showed a 1.9% rate of complications.
These findings oppose those of previous studies such as one presented last year at the American Heart Association annual meeting that found low volumes of angioplasties lead to poor patient outcomes. (See Cost Management in Cardiac Care, September 1997, p. 112.) But Lloyd Klein, MD, lead author of this year’s study and director of interventional cardiology at Rush-Presbyterian-St. Luke’s, says previous studies did not fit with his personal experience that many competent cardiologists provide high-quality interventions even though they do few procedures per year. "You can’t use volume as a surrogate for quality," Klein says. There may be some correlation between volume and outcomes, he says, but other factors such as the operator’s skill level and the patient’s degree of risk matter as well. Other important factors include having a supportive nursing and technical staff and sharing ideas among colleagues.
Reference
1. Klein, Lloyd W. Does Low Individual Operator Coronary Interventional Procedural Volume Correlate With Worse Institutional Procedural Outcome? J Am Coll Cardiol 1997; 30:870-877.
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