Abstract 16538: The Impact of Institutional Design on Transcatheter Aortic Valve Replacement Complication Rates in the United States

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Sadip Pant ◽  
Samir Patel ◽  
Harsh Golwala ◽  
Nilesh Patel ◽  
Apurva Badheka ◽  
...  
Keyword(s):  
United States ◽  
Heart Surgery ◽  
Institutional Design ◽  
Open Heart Surgery ◽  
Hospital Setting ◽  
The United States ◽  
Hospital Inpatient ◽  
Complication Rates ◽  
Hospital Size ◽  
The Impact

Introduction: With the technical advancements and expanding indications, utilization of TAVR is on the rise among various institutions in the United States .While appropriate patient selection and better techniques are essential to improving outcomes, the impact of institutional design (or hospital setting) on outcomes with TAVR has yet to be examined. Objective: The objective of our study is to compare TAVR complication rates among teaching vs non-teaching centers in the United States Methods: We used Healthcare Cost and Utilization Project - National Inpatient Sample (NIS) data , the largest all payer database of hospital inpatient stay available in United States, to identify patients (age ≥18 years) who underwent TAVR from Jan-Dec 2012. We constructed multivariable models to determine independent predictors (age, sex, race, Charlson’s comorbidity index, hospital size, hospital location and TAVR approach) of TAVR-associated complications. Statistical analysis was performed using Stata IC 11.0 (Stata-Corp, College Station, TX). Results: We identified 7,405 TAVR procedures performed in the United States in 2012. 88% of TAVR were performed in teaching centers. There was no difference in mortality following TAVR between teaching and non-teaching centers. The occurrence of any in-hospital complication was lower in teaching centers as compared to non-teaching centers (42% vs. 50%, p<0.001). Rates of individual complications in teaching vs. non-teaching centers are illustrated in the figure. In adjusted analysis, hemorrhage requiring transfusion (13.2% vs. 20.8%, p<0.001), renal complications requiring dialysis (1.2% vs. 2.3%, p=0.009), respiratory complications (7.5% vs. 11%, p<0.001) and complications requiring open-heart surgery (2% vs. 4.6%, p<0.001) were lower in teaching centers as compared to non-teaching centers. Vascular access site complications, pacemaker insertion, pericardial and neurological complications were similar between teaching and non-teaching centers (Figure). Conclusion: Institutional design impacts TAVR complication rates albeit no difference in mortality. In general, complication rates are lower in teaching centers compared to non-teaching centers.

scholarly journals Reduced Risk of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From a United States Claims Database

2021 ◽  
Vol 12 ◽  
Author(s):  
Chengyuan Wu ◽  
Sean J. Nagel ◽  
Rahul Agarwal ◽  
Monika Pötter-Nerger ◽  
Wolfgang Hamel ◽  
...  
Keyword(s):  
United States ◽  
Risk Reduction ◽  
De Novo ◽  
The United States ◽  
Secondary Outcome ◽  
Administrative Claims ◽  
Complication Rates ◽  
Claims Database ◽  
The Impact ◽  
Deep Brain

Objective: There have been significant improvements in the design and manufacturing of deep brain stimulation (DBS) systems, but no study has considered the impact of modern systems on complications. We sought to compare the relative occurrence of reoperations after de novo implantation of modern and traditional DBS systems in patients with Parkinson's disease (PD) or essential tremor (ET) in the United States.Design: Retrospective, contemporaneous cohort study.Setting: Multicenter data from the United States Centers for Medicare and Medicaid Services administrative claims database between 2016 and 2018.Participants: This population-based sample consisted of 5,998 patients implanted with a DBS system, of which 3,869 patients had a de novo implant and primary diagnosis of PD or ET. Follow-up of 3 months was available for 3,810 patients, 12 months for 3,561 patients, and 24 months for 1,812 patients.Intervention: Implantation of a modern directional (MD) or traditional omnidirectional (TO) DBS system.Primary and Secondary Outcome Measures: We hypothesized that MD systems would impact complication rates. Reoperation rate was the primary outcome. Associated diagnoses, patient characteristics, and implanting center details served as covariates. Kaplan–Meier analysis was performed to compare rates of event-free survival and regression models were used to determine covariate influences.Results: Patients implanted with modern systems were 36% less likely to require reoperation, largely due to differences in acute reoperations and intracranial lead reoperations. Risk reduction persisted while accounting for practice differences and implanting center experience. Risk reduction was more pronounced in patients with PD.Conclusions: In the first multicenter analysis of device-related complications including modern DBS systems, we found that modern systems are associated with lower reoperation rates. This risk profile should be carefully considered during device selection for patients undergoing DBS for PD or ET. Prospective studies are needed to further investigate underlying causes.

Estimate of the Annual Number of Percutaneous Injuries Among Hospital-Based Healthcare Workers in the United States, 1997–1998

2004 ◽  
Vol 25 (7) ◽  
pp. 556-562 ◽  
Author(s):  
Adelisa L. Panlilio ◽  
Jean G. Orelien ◽  
Pamela U. Srivastava ◽  
Janine Jagger ◽  
Richard D. Cohn ◽  
...  
Keyword(s):  
United States ◽  
Healthcare Workers ◽  
Hospital Setting ◽  
The United States ◽  
Annual Number ◽  
Healthcare Settings ◽  
Care Workers ◽  
Prevention Interventions ◽  
The Impact ◽  
Combined Data

AbstractObjective:To construct a single estimate of the number of percutaneous injuries sustained annually by healthcare workers (HCWs) in the United States.Design:Statistical analysis.Methods:We combined data collected in 1997 and 1998 at 15 National Surveillance System for Health Care Workers (NaSH) hospitals and 45 Exposure Prevention Information Network (EPINet) hospitals. The combined data, taken as a sample of all U.S. hospitals, were adjusted for underreporting. The estimate of the number of percutaneous injuries nationwide was obtained by weighting the number of percutaneous injuries at each hospital by the number of admissions in all U.S. hospitals relative to the number of admissions at that hospital.Results:The estimated number of percutaneous injuries sustained annually by hospital-based HCWs was 384,325 (95% confidence interval, 311,091 to 463,922). The number of percutaneous injuries sustained by HCWs outside of the hospital setting was not estimated.Conclusions:Although our estimate is smaller than some previously published estimates of percutaneous injuries among HCWs, its magnitude remains a concern and emphasizes the urgent need to implement prevention strategies. In addition, improved surveillance could be used to monitor injury trends in all healthcare settings and evaluate the impact of prevention interventions.

“Rendering the Majority Unable”

World Affairs ◽  
2016 ◽  
Vol 179 (3) ◽  
pp. 24-58
Author(s):  
David Mena Alemán
Keyword(s):  
United States ◽  
Comparative Politics ◽  
Institutional Design ◽  
The United States ◽  
Entire Family ◽  
Founding Fathers ◽  
Gini Coefficients ◽  
Democratic System ◽  
The Impact ◽  
Critical Questioning

The Founding Fathers conceived formal counter-majoritarian restrictions aimed specifically to “render the majority unable”: to prevent the majority from trampling on minorities in the U.S. democratic system. This article contends that several such formal restrictions actually fail to protect contemporary minorities as the founders imagined they would. Indeed, counter-majority restrictions embedded in the Electoral College, the Senate, and the judicial review may actually prohibit such protection. Using a comparative politics approach, this article builds on theoretical arguments and data that evaluate democratic functionality and fairness based on level of social equality provisions as well as optimality of voter participation. I find that certain counter-majoritarian procedures are empirically linked to higher inequality levels across twenty-one advanced democracies. This political suboptimality is reflected in a significant correlation between higher Gini coefficients and majoritarian systems (with the United States in first place) in the sample and also between lower scores and consensus democracies. I argue that comparative analysis shows that some criticisms hitherto only leveled at the United States are present in an entire family of systems—the majoritarian ones—which begs significant critical questioning of the impact of institutional design on the effectiveness of social policies and inclusive democratic procedures.

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