Influence of hospital volume on outcomes of percutaneous atrial septal defect and patent foramen ovale closure: A 10-years us perspective

Vikas Singh, Apurva O. Badheka, Nileshkumar J. Patel, Ankit Chothani, Kathan Mehta, Shilpkumar Arora, Nilay Patel, Abhishek Deshmukh, Neeraj Shah, Ghanshyambhai T. Savani, Ankit Rathod, Sohilkumar Manvar, Badal Thakkar, Vinaykumar Panchal, Jay Patel, Igor F. Palacios, Charanjit S. Rihal, Mauricio G. Cohen, William O'Neill, Eduardo De Marchena

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Contemporary data regarding percutaneous closure of atrial septal defect/patent foramen ovale (ASD/PFO) are lacking. We evaluated the current trends in utilization of ASD/PFO closure in adults and investigated the effect of annual hospital volume on in-hospital outcomes. Methods: We queried the Nationwide Inpatient Sample between the years 2001 and 2010 using the International Classification of Diseases (ICD-9-CM) procedure code for percutaneous closure of ASD/PFO with device. Hierarchical mixed effects models were generated to identify the independent multivariate predictors of outcomes. Results: A total of 7,107 percutaneous ASD/PFO closure procedures (weighted n = 34,992) were available for analysis. A 4.7-fold increase in the utilization of this procedure from 3/million in 2001 to 14/million adults in 2010 in US (P < 0.001) was noted. Overall, percutaneous ASD/PFO closure was associated with 0.5% mortality and 12% in-hospital complications. The utilization of intracardiac echocardiography (ICE) increased 15 fold (P < 0.001) during the study period. The procedures performed at the high volume hospitals [2nd (14-37 procedures/year) and 3rd (>38 procedures/year) tertile] were associated with significant reduction in complications, length of stay and cost of hospitalization when compared to those performed at lowest volume centers (<13 procedures/year). Majority (70.5%) of the studied hospitals were found to be performing <10 procedures/year hence deviating from the ACC/AHA/SCAI clinical competency guidelines. Conclusions: Low hospital volume is associated with an increased composite (mortality and procedural complications) adverse outcome following ASD/PFO closure. In the interest of patient safety, implementation of the current guidelines for minimum required annual hospital volume to improve clinical outcomes is warranted.

Original languageEnglish (US)
Pages (from-to)1073-1081
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Issue number6
StatePublished - May 1 2015


  • atrial septal defect
  • closure complication
  • cost
  • length of stay
  • patent foramen ovale
  • percutaneous

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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