Carotid artery stenting in the nation: the influence of hospital and physician volume on outcomes.

OBJECTIVES

To assess national outcomes of carotid artery stenting (CAS) with respect to hospital and practitioner volume.

METHODS

The 2005 to 2006 Nationwide Inpatient Sample (NIS) was used to assess CAS with respect to hospital volume, physician volume, and associated complications.

RESULTS

Eighteen thousand five hundred ninety-nine CAS interventions were identified. The top 25% was used to define high-volume hospitals (>60 CAS/2 years) and practitioners (>30 CAS/2 years). The stroke rate after CAS was significantly different between low- and high-volume hospitals (2.35% vs 1.78%, respectively; P = .0206). The stroke rate after CAS was also significantly different between low- and high-volume practitioners (2.19% vs 1.51%, P = .0243). Hospital resource use varied significantly between low- and high-volume hospitals (length of stay [LOS]: 1.64 +/- 2.10 vs 1.45 +/- 11.21, P = .0006; total charges: $32 261 +/- 20 562 vs $30 131 +/- 19 592, P = .0047) and practitioners (LOS: 1.70 +/- 2.14 vs 1.36 +/- 1.36; P < .0001; total charges: $33 762 +/- 21 081 vs $23 957 +/- 19 713; P < .0001).

CONCLUSIONS

This analysis demonstrates that hospital and physician volume are associated with outcomes and utilization after CAS. High-volume hospitals and practitioners were associated with lower procedure stroke rates and decreased hospital resource utilization.