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Geography or pathology? Regional variation in atrial septal defect closure rates and techniques

Published online by Cambridge University Press:  08 June 2011

Wendy L. Walker
Affiliation:
School of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
Tara Karamlou
Affiliation:
Seattle Children's Hospital, Seattle, Washington, United States of America
Brian S. Diggs
Affiliation:
Department of Surgery, Oregon Health & Science University, Portland, Oregon, United States of America
Eric I. Ehieli
Affiliation:
Jefferson Medical College, Philadelphia, Pennsylvania, United States of America
Kirk A. Caddell
Affiliation:
School of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
J. S. de la Cruz
Affiliation:
School of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
Karl F. Welke
Affiliation:
Mary Bridge Children's Hospital, Multicare Health System, Tacoma, Washington, United States of America
Corresponding
E-mail address:

Abstract

Background

Since the introduction of percutaneous closure in the United States, rates of secundum atrial septal defect and patent foramen ovale closures have increased substantially. Whether or not closure rates are uniform or vary due to differences in regional practice patterns is unknown. We sought to investigate this by comparing regional rates of closure across Florida.

Methods

We identified all atrial septal defect closures from 2001 to 2006 in the Florida State Inpatient Database. Using small area analysis, zip codes were assigned to Hospital Referral Regions based on where patients were most likely to go for closure. We obtained population-normalised rates of overall, percutaneous, and surgical closure.

Results

Of 1830 atrial septal defect and patent foramen ovale closures from 2001 to 2006, 751 were surgical and 1004 were percutaneous. The statewide closure rate was 1.91 per 100,000 people per year; regional rates varied 3.8-fold from 0.78 to 2.94 per 100,000 people per year. Percutaneous rates varied sevenfold from 0.25 to 1.75 per 100,000 people per year, while surgical rates varied 2.71-fold from 0.53 to 1.44 per 100,000 people per year.

Conclusions

Despite a consistent prevalence of atrial septal defects, and patent foramens ovale, rates of repair vary across regions, suggesting that closure is driven by provider practice patterns rather than patient pathology. Efforts should be directed towards increasing consensus regarding the appropriate, evidence-based indications for closure so as to avoid the costs and potential negative sequelae of over- or undertreatment.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2011

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