The Impact of Center Volume on Outcomes in Lung Transplantation.
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
received:
05
11
2020
revised:
13
03
2021
accepted:
26
03
2021
pubmed:
16
4
2021
medline:
9
4
2022
entrez:
15
4
2021
Statut:
ppublish
Résumé
Studies in lung transplantation have shown variable association between hospital volume and clinical outcomes. We aimed to identify the pattern of effect of hospital volume on individual patient survival after lung transplantation. We performed a retrospective analysis using the United Network for Organ Sharing national thoracic organ transplantation database. Adult patients who underwent lung transplantation between January 2013 and December 2017 were included. The association between mean annual center volume and 1-year overall survival was examined using restricted cubic splines in a random effects multivariable Cox model. The volume threshold for optimal 1-year overall survival was subsequently approximated by the maximum likelihood approach using segmented linear splines in the same model. The study included 10,007 patients at 71 transplant centers. Median annual center volume was 22 cases (interquartile range, 10.6 to 38). A center volume threshold was identified at 33 cases per year (95% confidence interval, 28 to 37). Higher center volume, to 33 cases per year, was associated with better 1-year survival (hazard ratio 0.989, 95% confidence interval, 0.980 to 0.999 every additional case). Further increase in center volume above 33 cases per year showed no additional benefit (hazard ratio 1.000, 95% confidence interval, 0.996 to 1.003 every additional case). Twenty-three centers (32.4%) reached the volume threshold of 33 cases per year. One-year survival after lung transplantation improved with increasing center volume to as many as 33 cases per year. Low volume centers below the 33 cases per year threshold had large variations in their outcomes and had a higher risk of performing poorly, although many of them maintained good performance.
Sections du résumé
BACKGROUND
Studies in lung transplantation have shown variable association between hospital volume and clinical outcomes. We aimed to identify the pattern of effect of hospital volume on individual patient survival after lung transplantation.
METHODS
We performed a retrospective analysis using the United Network for Organ Sharing national thoracic organ transplantation database. Adult patients who underwent lung transplantation between January 2013 and December 2017 were included. The association between mean annual center volume and 1-year overall survival was examined using restricted cubic splines in a random effects multivariable Cox model. The volume threshold for optimal 1-year overall survival was subsequently approximated by the maximum likelihood approach using segmented linear splines in the same model.
RESULTS
The study included 10,007 patients at 71 transplant centers. Median annual center volume was 22 cases (interquartile range, 10.6 to 38). A center volume threshold was identified at 33 cases per year (95% confidence interval, 28 to 37). Higher center volume, to 33 cases per year, was associated with better 1-year survival (hazard ratio 0.989, 95% confidence interval, 0.980 to 0.999 every additional case). Further increase in center volume above 33 cases per year showed no additional benefit (hazard ratio 1.000, 95% confidence interval, 0.996 to 1.003 every additional case). Twenty-three centers (32.4%) reached the volume threshold of 33 cases per year.
CONCLUSIONS
One-year survival after lung transplantation improved with increasing center volume to as many as 33 cases per year. Low volume centers below the 33 cases per year threshold had large variations in their outcomes and had a higher risk of performing poorly, although many of them maintained good performance.
Identifiants
pubmed: 33857492
pii: S0003-4975(21)00673-1
doi: 10.1016/j.athoracsur.2021.03.092
pmc: PMC8505551
mid: NIHMS1703536
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
911-917Subventions
Organisme : NCI NIH HHS
ID : P30 CA091842
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL146856
Pays : United States
Informations de copyright
Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Références
J Clin Oncol. 2017 Aug 20;35(24):2772-2780
pubmed: 28682689
N Engl J Med. 1979 Dec 20;301(25):1364-9
pubmed: 503167
J Heart Lung Transplant. 2018 Oct;37(10):1169-1183
pubmed: 30293613
J Thorac Dis. 2019 May;11(5):1867-1878
pubmed: 31285879
Transplantation. 2010 Mar 27;89(6):639-43
pubmed: 20075790
Fed Regist. 2007 Mar 30;72(61):15197-280
pubmed: 17450666
J Thorac Dis. 2019 Mar;11(Suppl 3):S413-S416
pubmed: 30997234
Stat Med. 2003 Oct 15;22(19):3055-71
pubmed: 12973787
Ann Thorac Surg. 2020 Jul;110(1):276-283
pubmed: 32184113
Am J Transplant. 2017 Feb;17(2):485-495
pubmed: 27618731
JAMA Netw Open. 2018 Nov 2;1(7):e184595
pubmed: 30646367
Ann Am Thorac Soc. 2016 Jul;13(7):1034-41
pubmed: 27064753
Crit Care Med. 2014 May;42(5):1089-95
pubmed: 24368346
Bone Marrow Transplant. 2020 Apr;55(4):675-680
pubmed: 31576022
Epidemiology. 1995 Jul;6(4):450-4
pubmed: 7548361
Thorac Surg Clin. 2017 Aug;27(3):251-256
pubmed: 28647071
PLoS One. 2017 Jul 21;12(7):e0181846
pubmed: 28732093
Ann Thorac Surg. 2012 Sep;94(3):695-702
pubmed: 22626758
J Multidiscip Healthc. 2013 Aug 22;6:293-302
pubmed: 24009423
Ann Thorac Surg. 2009 Oct;88(4):1062-70
pubmed: 19766782
Med Care. 2011 Dec;49(12):1076-81
pubmed: 22002649
Ann Thorac Surg. 2003 Mar;75(3):1048-58
pubmed: 12645752
J Thorac Cardiovasc Surg. 2012 Dec;144(6):1502-8; discussion 1508-9
pubmed: 22995727
Heart Lung. 2017 Sep - Oct;46(5):351-356
pubmed: 28624338