Linking high volume to better outcomes in TAVR

If you want something done well, ask a busy person. That was one of my dad’s adages over the years. The same is true in healthcare, as many studies have found that volume—busy-ness—and quality in medicine go hand in hand.

The relationship between volume and outcomes in surgery is well-known. Most of us seek out a high-volume surgeon when we need a procedure and want a good outcome. But little has been known about the connection between volume and outcomes for medical conditions.

A study in the New England Journal of Medicine in March found that patients suffering from heart attack, heart failure and pneumonia fare better in hospitals that see more of these patients than in those that see relatively few. While the researchers found that higher-volume hospitals have slightly better outcomes, with fewer deaths over 30 days, once the number of these patients reaches a certain threshold the outcomes are the same regardless of the size of the hospital.  

Last week at HRS we saw for the first time a link emerge between high volume and good outcomes for transcatheter aortic valve replacements (TAVR). A JAMA Cardiology study released last week shows a correlation between high-volume TAVR hospitals and lower 30-day readmission rates. Thus, increasing productivity among cardiologists performing TAVR could potentially help lower readmissions and associated costs.

The study, led by Sahil Khera, MD, a cardiologist at Westchester Medical Center in Valhalla, New York, classified low-functioning hospitals as those doing fewer than 50 TAVR procedures a year and high functioning ones that perform more than 100. Of the 129 hospitals in the study, 48.1 percent were high functioning.

The results showed that 30-day readmissions were significantly lower in the high-volume centers but there were no significant differences in length of stay and costs per readmission among the three segments of low, medium and high-functioning facilities.

Other research has shown that the average 30-day readmission rate for patients who underwent TAVR procedures was 17.9 percent. This study included 2,600 total readmissions. Of them, 61.7 percent were because of noncardiac causes, with 39.3 percent due to cardiac issues.

So what’s the reason? “Multifactorial and depends on patient factors, operator factors, hospital systems, and community factors,” the researchers wrote. “Low-volume hospitals had a higher proportion of noncardiac readmissions (infections and respiratory) compared with high-volume hospitals, likely driven by patient factors and procedural approach selection.”

The adage holds true. If you want something done well, find that busy person.