{
  "abstract": "Background The complication risk of procedures may be influenced by operator and institutional characteristics. Our aim was to assess whether supervising consultant seniority and operative volume, and hospital volume were associated with the risk of reintervention following complex device implantation.Methods A nationwide population-based study was performed using the National Institute for Cardiovascular Outcomes Research registry including all patients receiving their first transvenous implantable cardioverter defibrillator or cardiac resynchronisation therapy (CRT) implant in England over 5 years (April 2014–March 2019). The primary endpoint was 1-year reintervention. We evaluated the association between reintervention and supervising consultant annualised complex device volume, supervising consultant seniority and hospital annualised complex device volume, using multilevel logistic regression.Results 47 630 implants were included. The 1-year reintervention rate was 6.1% (N=2916). There was no difference in reintervention risk with increasing supervising consultant volume (OR 0.89 Q4 vs Q1; 95% CI 0.76 to 1.05, p=0.17). When CRT-pacemakers/defibrillators implants were analysed separately (N=26 108), there was an association between operator volume and 1-year reintervention, but this was of borderline statistical significance and only evident in the highest compared with the lowest volume quartile of operators (adjusted OR 0.79 Q4 vs Q1; 95% CI 0.63 to 0.98, p=0.03). There was a non-linear relationship between reintervention risk and supervising consultant seniority, with the operators in the middle two quartiles of seniority having a lower risk (OR 0.87 Q2 vs Q1, p=0.02; OR 0.81 Q3 vs.Q1; p=0.003) while the most and least senior operators had a similar reintervention risk (OR 0.93 Q4 vs Q1, p=0.31). Hospital volume was not associated with 1-year reintervention.Conclusions There is a U-shaped curve between operator seniority and reintervention risk for complex devices. Although there are several potential explanations, these data suggest that while newly qualified consultants may benefit from mentoring, all operators should continuously evaluate their outcomes and share them within their centre and more widely through the national audit.",
  "authors": [
    {
      "affiliations": [
        "King’s British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, UK",
        "National Institute for Cardiovascular Outcomes Research (NICOR), NHS Arden & GEM Commissioning Support Unit, Leicester, UK"
      ],
      "name": "Paul A Scott"
    },
    {
      "affiliations": [
        "King’s British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, UK"
      ],
      "name": "Antonio Cannata"
    },
    {
      "affiliations": [
        "King’s British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, UK"
      ],
      "name": "Daniel I Bromage"
    },
    {
      "affiliations": [
        "Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK"
      ],
      "name": "Ian J Wright"
    },
    {
      "affiliations": [
        "National Institute for Cardiovascular Outcomes Research (NICOR), NHS Arden & GEM Commissioning Support Unit, Leicester, UK",
        "Department of Cardiology, Barts Health NHS Trust, London, UK",
        "Institute of Cardiovascular Sciences, University College London, London, UK"
      ],
      "name": "Anish Bhuva"
    },
    {
      "affiliations": [
        "National Institute for Cardiovascular Outcomes Research (NICOR), NHS Arden & GEM Commissioning Support Unit, Leicester, UK",
        "Department of Cardiology, Royal Devon and Exeter Hospital, Exeter, UK"
      ],
      "name": "Matthew J Lovell"
    },
    {
      "affiliations": [
        "Department of Cardiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK"
      ],
      "name": "Chris Plummer"
    },
    {
      "affiliations": [
        "National Institute for Cardiovascular Outcomes Research (NICOR), NHS Arden & GEM Commissioning Support Unit, Leicester, UK"
      ],
      "name": "Mark de Belder"
    },
    {
      "affiliations": [
        "National Institute for Cardiovascular Outcomes Research (NICOR), NHS Arden & GEM Commissioning Support Unit, Leicester, UK",
        "Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland",
        "Faculty of Health, University of Plymouth, Plymouth, UK"
      ],
      "name": "Mark Dayer"
    },
    {
      "affiliations": [
        "King’s British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, UK",
        "National Institute for Cardiovascular Outcomes Research (NICOR), NHS Arden & GEM Commissioning Support Unit, Leicester, UK"
      ],
      "name": "Francis Murgatroyd"
    }
  ],
  "title": "Complications after complex device implantation: how important is implanter seniority?",
  "uid": "165e696d-d211-5a05-af97-8acefe091ee1"
}