LAUSR

nos. 442-451 TCT CONNECT-442 Association of Hospital Procedure Volume With Outcomes of Percutaneous Left Atrial Appendage Occlusion Salik Nazir, Keerat Rai Ahuja, Dhaval Kolte, Toshiaki Isogai, Nobuaki Michihata, Anas Saad, P. Kasi Ramanathan, Walid Saliba, Oussama Wazni, Amar Krishnaswamy, Samir Kapadia University of Toledo, Toledo, Ohio; Cleveland Clinic Foundation, Beachwood, Ohio; Massachusetts General Hospital, Boston, Massachusetts; Cleveland Clinic, Cleveland, Ohio; The University of Tokyo, Tokyo, Japan; Promedica Toledo Hospital, Ottawa Hills, Ohio; Cleveland Clinic Foundation, Cleveland, Ohio BACKGROUND Several studies have reported an inverse volume– outcomes relationship for patients undergoing invasive cardiac procedures. Whether a similar association exists for percutaneous left atrial appendage occlusion (LAAO) remains unknown. METHODS Patients undergoing LAAO (International Classification of Diseases-10th Revision-Clinical Modification code 02L73DK) between January and December 2017 were identified in the Nationwide Readmissions Database. Hospitals were categorized into 3 groups based on tertiles of annual procedural volume: low (5 to 15 cases/year), medium (17 to 31 cases/year), and high (32 to 211 cases/year). Hospitals with fewer than 5 annual procedures were excluded. Multivariable hierarchical logistic regression analyses were performed to examine the impact of institutional volume on in-hospital predischarge outcomes. The primary outcome of interest was major adverse events defined as a composite of mortality, stroke/transient ischemic attack, bleeding/ transfusion, vascular complications, myocardial infarction, systemic embolization, and pericardial effusion/tamponade requiring pericardiocentesis or surgery. RESULTS The study included 5,949 procedures performed in 196 hospitalswith amedian annual procedure volume of 41 cases/year (interquartile range: 25 to 67). Low versus high hospital volume was associated with higher rates of major adverse events, stroke/transient ischemic attack, and bleeding/transfusion (Table). On multivariable analysis, lower hospital volume was associated with higher rates of in-hospital major adverse events (medium vs. low, adjusted odds ratio: 0.69; 95% confidence interval: 0.46 to 1.04; p 1⁄4 0.08; high vs. low, adjusted odds ratio: 0.55; 95% confidence interval: 0.37 to 0.82; p 1⁄4 0.003). Outcomes Overall N[ 5,949 Low volume 5-16 cases/year N[652 Medium volume 17-