Procedural volume and survival after lung transplantation in the United States: the need to look beyond volume in the establishment of quality metrics

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• 作者：Jeremiah A. Hayanga ; M.D. ; M.P.H.^a ; ^{jhayanga@me.com" class="auth_mail" title="E-mail the corresponding author} ; Alena Lira ; M.D.^b ; Tedi Vlahu ; M.D.^a ; Jonathan D'Cunha ; M.D. ; Ph.D.^c ; Heather K. Hayanga ; M.D. ; M.P.H.^d ; Reda Girgis ; M.D.^a ; Jonathan Aboagye ; M.D. ; M.P.H.^e ; Asghar Khaghani ; M.D.^a
• 关键词：Lung transplantation ; Volume ; Survival
• 刊名：The American Journal of Surgery
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：211
• 期：4
• 页码：671-676
• 全文大小：259 K

文摘

We sought to evaluate the effect of center volume on patient survival.

Methods

We performed a retrospective analysis on nationwide data from the Scientific Registry of Transplant Recipients provided by United Network for Organ Sharing pertaining to lung transplantation (LT) recipients transplanted between 2005 and 2013. Centers were categorized into 4 groups based on their annual volume as follows: less than 20, 20 to 29, 30 to 39, and greater than or equal to 40 LTs. Baseline characteristics were compared and Kaplan–Meier analysis was used to estimate survival.

Results

A total of 13,506 adult recipients underwent LT during the study period. Of these, 2,491 (18.4%) patients were transplanted in centers with volume less than 20, 2,562 (19.0%) in centers with volume 20 to 29, 2,998 (22.2%) in centers with volume 30 to 39, and 5,455(40.4%) in centers with volume greater than or equal to 40. Survival was poorest in the lowest volume centers (1-year 81.4% vs 85.5% and 5-year 49.7% vs 56.5%, respectively).

Conclusions

Post-LT survival in low volume centers is significantly lower than in high volume centers but the explanatory power of volume as a predictor of survival is low.