Reemplazo valvular aórtico percutáneo y quirúrgico.Influencia del volumen y del tipo de centro tratante en los resultados

  1. Iván Javier Núñez Gil 1
  2. Javier Elola 2
  3. María García Márquez 2
  4. José L. Bernal 3
  5. María Cristina Fernández Pérez 4
  6. A. Íñiguez Romo 5
  7. L. Nombela Franco 1
  8. Pilar Jiménez-Quevedo 1
  9. Javier Escaned 1
  10. Carlos Macaya Miguel 1
  11. Antonio Fernández-Ortiz 1
  1. 1 Servicio de Cardiología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
  2. 2 Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, España
  3. 3 Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Instituto de Investigación I+12, Madrid, España
  4. 4 Servicio de Medicina Preventiva y Estadística, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
  5. 5 Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
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Journal:
REC: Interventional Cardiology

ISSN: 2604-7276,  2604-7306

Year of publication: 2021

Volume: 3

Issue: 2

Pages: 103-111

Type: Article

DOI: 10.24875/RECIC.M20000149 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

More publications in: REC: Interventional Cardiology

Abstract

Introduction and objectives: To analyze if there is an association between certain structural variables of the treating centres (availability of cardiac surgery and an intensive care unit [CICU] led by cardiologists) and the volume of procedures performed that may be impacting the results of surgical (SAVR) or transcatheter (TAVI) aortic valve treatment. Methods: Retrospective and observational study of all patients discharged from hospitals from the Spanish National Health System who underwent a SAVR or a TAVI procedure. The source of the data was the administrative minimum basic data set. The outcome variables analyzed were in-hospital mortality, length of stay (both of them risk-adjusted), and presence of complications. As structural variables for the centers studied we used the availability of cardiac surgeries and CICU. Results: A total of 2055 TAVI and 15 146 SAVR episodes were identified. The adjustment models for in-hospital mortality showed good discrimination ( AUC for the SAVR and TAVI model: 0.84; 95%CI, 0.82-0.85) and calibration (P < .001). The model median odds ratio was 1.73, indicative of a high inter-hospital variability. High-volume hospitals, with cardiac surgery services, and CICU-capable centers had the lowest risk-adjusted mortality rate in both procedures. Conclusions:A consistent association is observed between the structural characteristics of the treating centers and the results of aortic valve management both surgical and transcatheter. Also, the availability of a CICU could be a relevant factor in the outcomes of these procedures.

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