Comparison of real-world clinical and economic outcomes between the ThermoCool® SF and ThermoCool® catheters in patients undergoing radiofrequency catheter ablation for atrial fibrillation.

INTRODUCTION: This study evaluated the real-world clinical and economic outcomes associated with the use of the ThermoCool® Surround Flow (SF) and ThermoCool® catheters in atrial fibrillation (AF) ablation. METHODS: Adults with AF who underwent catheter ablation between January 1, 2013, and December 31, 2016, in a hospital outpatient setting were identified from the Premier Healthcare Database. Using a search strategy of hospital-charge descriptors, patients were classified into two mutually exclusive groups: ThermoCool® SF catheter and ThermoCool® catheter. A generalized estimating equation was used to compare index admission cost. Survey logistic regression was used to compare the incidence of inpatient readmission, direct-current cardioversion (DCCV), and repeat ablation. Multivariable analyses were adjusted for hospital clustering and demographic, procedural, hospital, and comorbidity characteristics. RESULTS: There were 1,014 and 463 patients in the ThermoCool® SF and ThermoCool® groups, respectively. The ThermoCool® SF group had significantly lower odds of all-cause (odds ratio [OR] 0.45; 95% CI 0.27-0.76) and cardiovascular-related readmissions (OR 0.45; 95% CI 0.21-0.96), and DCCV (OR 0.61; 95% CI 0.42-0.88) than the ThermoCool® group. In patients susceptible to fluid overload, the ThermoCool® SF group had significantly lower odds of 12-month all-cause (OR 0.42; 95% CI 0.23-0.75), cardiovascular-related (OR 0.31; 95% CI 0.10-0.92), and AF-related readmissions (OR 0.18; 95% CI 0.04-0.80), and DCCV (OR 0.52; 95% CI 0.31-0.87) than the ThermoCool® group. CONCLUSIONS: Using the ThermoCool® SF catheter for AF ablation was significantly associated with improved clinical outcomes compared with the ThermoCool® catheter.

Breast Reconstruction Among Commercially Insured Women With Breast Cancer in the United States.

INTRODUCTION: This study evaluated trends related to breast reconstruction and the factors associated with reconstruction. METHODS: Women with breast cancer aged 19 to 64 years who underwent a mastectomy procedure between July 1, 2011, and September 30, 2014, were identified from the MarketScan Commercial Claims and Encounters Database. The first date of surgical procedure during this period was defined as the index date. Continuous enrollment during the 12-month preindex and postindex period was required, and the patient sample was followed for 12 months postindex. Multivariable regression analysis was used to determine factors associated with having breast reconstruction. RESULTS: Among the 17,502 women undergoing mastectomy during the study period, 73% (n = 12,816) had breast reconstruction, with 66% (n = 11,613) having immediate and 7% (n = 1203) having delayed reconstruction. Overall reconstruction rates increased during the study period from 69.47% in the third quarter of 2011 to 75.72% in the third quarter of 2014. The most common type of immediate reconstruction involved the use of tissue expanders (with or without implant and autologous reconstruction) (~77%), followed by implant reconstruction (9.67%), autologous reconstruction (10.81%), and other reconstruction (2.52%). Acellular dermal matrix was commonly used with immediate tissue expander and immediate implant-based reconstruction, and its use increased during the study period. Demographic and treatment-related factors were found to be associated with reconstruction among women undergoing mastectomy. CONCLUSIONS: In this commercial payor setting, most women undergoing mastectomy had breast reconstruction. Among women undergoing immediate reconstruction, tissue expander use was common. Several factors were shown to be associated with the decision to have breast reconstruction.

Use of the THERMOCOOL SMARTTOUCH catheter for ablation of atrial fibrillation: the relationship between hospital procedure volume, re-admissions, and economic outcomes.

OBJECTIVE: The purpose of this study was to examine the relationship between hospital volume of prior THERMOCOOL SMARTTOUCH catheter use and health and economic outcomes among hospitalized patients with atrial fibrillation (AF) undergoing ablation using this device. MATERIALS AND METHODS: Patients aged ≥18 years with a primary diagnosis of AF undergoing ablation treatment using the THERMOCOOL SMARTTOUCH catheter between January 2014 and June 2016 were identified from the Premier hospital database with the first date of such a procedure being defined as the index date. Hospital volume of prior THERMOCOOL SMARTTOUCH catheter use was determined during the 12-month pre-index period, and was classified into five groups: no volume (0), low volume (1-50), mid volume (51-100), high volume (101-150), and very high volume (≥151). Outcomes, including length of stay (LOS; for inpatient procedure only), hospital costs (total, hospital pharmacy, supply), and all-cause re-admission were evaluated. A generalized estimating equation (GEE) with exchangeable correlation structure was used to examine the impact of hospital volume on LOS, hospital costs, and re-admissions controlling for hospital clustering and other covariates. RESULTS: The study population included 640 hospitalized AF patients. The adjusted mean LOS was significantly shorter in very high-volume hospitals than hospitals with no volume (mean LOS 2.30 vs 4.33 days; p = .0377). As volume increased, the mean adjusted supply cost tended to decrease, although these changes emerged as non-significant. The 12-month all-cause re-admission was significantly lower among patients undergoing ablation in low (Odds ratio [OR] = 0.27; confidence interval [CI] = 0.08-0.85) and mid (OR = 0.12; CI = 0.02-0.61) volume hospitals compared to hospitals with no volume. LIMITATIONS: Study results may not be generalizable to all US hospitals. CONCLUSIONS: Among AF patients undergoing ablation, increased hospital volume of prior THERMOCOOL SMARTTOUCH catheter use was associated with shorter LOS and a lower likelihood of all-cause re-admission.