Abstract 4144347: Evaluating Hospital Volume Based Outcomes on Catheter Ablation for Atrial Fibrillation; A National Registry Study

Introduction: Catheter ablation is a common treatment of atrial fibrillation (AFib). However, the relationship between hospital procedural volume and patient outcomes remains unclear. This study aims to investigate whether the volume of catheter ablation procedures performed for AFib at a hospital influences patient outcomes. It is hypothesized that hospitals with higher procedure volumes will demonstrate superior outcomes due to staff expertise, protocols, and resource allocation. Methods: National Inpatient Sample (NIS) was queried from 2005 to 2020 for admissions involving catheter ablation for atrial fibrillation. Hospitals were divided into tertiles based on their volume of catheter ablation. Multivariable, Hierarchical logistic regression was utilized to assess risk factors of in-hospital mortality, discharge other than home (DOTH), and vascular complications. Negative binomial regression was utilized to assess factors of total charge and length of stay (LOS) of the two higher volume tertiles, to the first, lowest volume, tertile. Results: A total of 534,097 admissions were identified;182,354 (34.1%) in the lowest tertile, 178,525 (33.4%) in the 2nd tertile and 173,219 (32.4%) in the 3rd and highest tertile. Those in the 2nd and 3rd tertiles had similar odds of in-hospital mortality compared to the first tertile (2nd: OR: 1.05, p=0.62; 3rd: OR: 0.86, p=0.17). Those in the 2nd and 3rd tertiles had lower odds of DOTH compared to the first tertile (2nd: 0.85, p<0.001; 3rd: OR: 0.75, p<0.001). Those in the 2nd tertile had similar odds of vascular complications compared to the first tertile (OR: 0.87, p=0.16), while those in the 3rd tertile had lower odds of vascular complications (OR: 0.71, p=0.001). Compared to the first tertile, those in the 2nd and 3rd tertiles were associated with lower average LOS by 9.7% (p<0.001) and 20.4% (p<0.001), respectively. There was no difference in total charge among the 2nd and 3rd tertiles compared to the first tertile (2nd: Coef: -1.9%, p=0.17; 3rd: Coef: 0.9%, p=0.69). Conclusions: Higher hospital volumes for catheter ablation procedures may be associated with lower odds of DOTH and vascular complications as well as lower average LOS. However, in-hospital mortality and total charge was comparable among the three tertiles. Further research is needed to fully understand the relationship between hospital catheter ablation volume and patient outcomes, including postoperative management and discharge planning.