OUTCOMES OF DEFIBRILLATOR LEAD IMPLANTS PERFORMED BY HIGH VOLUME VERSUS LOW VOLUME OPERATORS: RESULTS FROM THE PACEMAKER AND IMPLANTABLE DEFIBRILLATOR LEADS SURVIVAL STUDY ("PAIDLESS")
A. Feldman, J. Chung, D. Kersten, S. Islam, W. Asheld, J. Germano, T. Cohen
Department of Medicine, Winthrop University Hospital, Mineola, USA
Introduction:: This study investigated the effects of operator volume on implantable defibrillator lead failure.
Methods: High and low volume operators were analyzed based on patient characteristics and lead failure. High volume operators were defined as performing > 500 implants at Winthrop University Hospital between 1996 and 2011. Statistical analyses included T-tests, Chi-Square tests, and Kaplan-Meier analysis.
Results: Four of eight operators were high volume. Of 4078 implants, high volume operators performed 3375(83%) of them. They operated more on men (75 versus 69%; p=0.0006), older patients (71+12 versus 68+13 years; p < 0.0001), had longer follow up (4+3 versus 2+2 years; p < 0.0001), and implanted mostly Medtronic leads (52 vs 10%). High volume operators implanted more recalled leads (42 versus 12%; p < 0.0001). They had more lead failures (136(4%) vs 17(2%) failures; p=0.0408) but Kaplan-Meier analysis found that time to failure was not significantly shorter (p=0.0806).
Conclusions: Contrary to previous studies, high volume operators used more recalled leads and had more lead failures than low volume operators. Further research is needed to better understand the impact of operator volume on procedure preferences and outcomes.
