Association between hospital liver transplantation volume and mortality after liver re-transplantation

Background The relationship between institutional liver transplantation (LT) case volume and clinical outcomes after liver re-transplantation is yet to be determined. Methods Patients who underwent liver re-transplantation between 2007 and 2016 were selected from the Korean National Healthcare Insurance Service database. Liver transplant centers were categorized to either high-volume centers (≥ 64 LTs/year) or low-volume centers (< 64 LTs/year) according to the annual LT case volume. In-hospital and long-term mortality after liver re-transplantation were compared. Results A total of 258 liver re-transplantations were performed during the study period: 175 liver re-transplantations were performed in 3 high-volume centers and 83 were performed in 21 low-volume centers. In-hospital mortality after liver re-transplantation in high and low-volume centers were 25% and 36% (P = 0.069), respectively. Adjusted in-hospital mortality was not different between low and high-volume centers. Adjusted 1-year mortality was significantly higher in low-volume centers (OR 2.14, 95% CI 1.05–4.37, P = 0.037) compared to high-volume centers. Long-term survival for up to 9 years was also superior in high-volume centers (P = 0.005). Other risk factors of in-hospital mortality and 1-year mortality included female sex and higher Elixhauser comorbidity index. Conclusion Centers with higher case volume (≥ 64 LTs/year) showed lower in-hospital and overall mortality after liver re-transplantation compared to low-volume centers.

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Institutional volume affects long-term survival following lung transplantation in the USA

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz014 ◽

2019 ◽

Vol 56 (2) ◽

pp. 271-276 ◽

Cited By ~ 6

Author(s):

Arman Kilic ◽

Thomas G Gleason ◽

Hiroshi Kagawa ◽

Ahmet Kilic ◽

Ibrahim Sultan

Keyword(s):

Lung Transplantation ◽

High Volume ◽

Term Survival ◽

Long Term Survival ◽

Kaplan Meier ◽

The Usa ◽

Institutional Volume ◽

Low Volume ◽

The Impact

Abstract OBJECTIVES The aim of this study was to evaluate the impact of institutional volume on long-term outcomes following lung transplantation (LTx) in the USA. METHODS Adults undergoing LTx were identified in the United Network for Organ Sharing registry. Patients were divided into equal size tertiles according to the institutional volume. All-cause mortality following LTx was evaluated using the risk-adjusted multivariable Cox regression and the Kaplan–Meier analyses, and compared between these volume cohorts at 3 points: 90 days, 1 year (excluding 90-day deaths) and 10 years (excluding 1-year deaths). Lowess smoothing plots and receiver-operating characteristic analyses were performed to identify optimal volume thresholds associated with long-term survival. RESULTS A total of 13 370 adult LTx recipients were identified. The mean annual centre volume was 33.6 ± 20.1. After risk adjustment, low-volume centres were found to be at increased risk for 90-day mortality, [hazard ratio (HR) 1.56, P < 0.001], 1-year mortality excluding 90-day deaths (HR 1.46, P < 0.001) and 10-year mortality excluding 1-year deaths (HR 1.22, P < 0.001). These findings persisted when the centre volume was modelled as a continuous variable. The Kaplan–Meier analysis also demonstrated significant reductions in survival at each of these time points for low-volume centres (each P < 0.001). The 10-year survival conditional on 1-year survival was 37.4% in high-volume centres vs 28.0% in low-volume centres (P < 0.001). The optimal annual volume threshold for long-term survival was 26 LTx/year. CONCLUSIONS The institutional volume impacts long-term survival following LTx, even after excluding deaths within the first post-transplant year. Identifying the processes of care that lead to longer survival in high-volume centres is prudent.

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Impact of radiotherapy facility volume on the management and survival of patients with muscle-invasive bladder cancer receiving bladder-preserving therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.18 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 18-18

Author(s):

Kevin D'Rummo ◽

Mindi TenNapel ◽

Xinglei Shen

Keyword(s):

Bladder Cancer ◽

Charlson Comorbidity Index ◽

High Volume ◽

Case Volume ◽

Muscle Invasive Bladder Cancer ◽

Bladder Preservation ◽

Nccn Guidelines ◽

Comorbidity Index ◽

Low Volume ◽

Muscle Invasive

18 Background: Higher facility surgical volume predicts for improved survival in patients with muscle-invasive bladder cancer (MIBC) who undergo radical cystectomy. Here, we investigated the association between facility radiotherapy (RT) case volume and compliance with National Comprehensive Cancer Network (NCCN) guidelines as well as overall survival (OS) for patients with MIBC receiving radiation-based bladder preservation. Methods: The National Cancer Database (NCDB) was used to identify patients who were diagnosed with non-metastatic MIBC from 2004 to 2015 and received RT at the reporting institution. Patient, tumor, and treatment characteristics were recorded. Facility RT case volume was defined as the summed MIBC cases treated with RT during the study period. Facilities were divided into high or low volume groups at the 80th percentile of RT case volume. We compared compliance with NCCN guidelines regarding total RT dose of at least 55 Gy, use of TURBT prior to RT, and planned use of concurrent chemotherapy using the χ2 test. OS was assessed using Kaplan-Meier method. A Cox proportional hazard model was used to evaluate predictors of survival. Results: There were 7,562 included patients, and 3,816 (50.5%) were treated at a high-volume center. Median RT case volume was 21 for high-volume centers versus 8 cases for low-volume centers. Higher rates of compliance with all three NCCN recommendations were observed at high-volume centers (48% vs 41%, P< .0001). Age, sex, tumor stage, nodal status, Charlson Comorbidity Index, insurance status, and use of a TURBT prior to RT were predictive of survival. Volume as a continuous variable was an independent predictor of OS ( P= .002). Treatment at a high-volume facility was associated with significantly greater OS for all patients (log-rank P= .001), including patients with a Charlson Comorbidity Index of 0 ( P= .012). Further division of facilities into quartiles revealed incremental improvement in OS with higher facility volume ( P= .001). Conclusions: Bladder preservation treatment at a high-volume facility is associated with greater guideline-concordant management and improved OS among patients with MIBC.

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Overcoming a travel burden to high-volume centers for treatment of retroperitoneal sarcomas is associated with improved survival

World Journal of Surgical Oncology ◽

10.1186/s12957-019-1728-z ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

Robin Schmitz ◽

Mohamed A. Adam ◽

Dan G. Blazer

Keyword(s):

Tumor Grade ◽

High Volume ◽

National Study ◽

Short Term ◽

Term Survival ◽

Low Volume ◽

Retroperitoneal Sarcomas ◽

Centralized Care ◽

Travel Burden

Abstract Background Guidelines recommend treatment of retroperitoneal sarcomas (RPS) at high-volume centers. However, high-volume centers may not be accessible locally. This national study compared outcomes of RPS resection between local low-volume centers and more distant high-volume centers. Methods Patients treated for RPS were identified from the National Cancer Database (1998–2012). Travel distance and annual hospital volume were divided into quartiles. Two groups were identified: (1) short travel to low-volume hospitals (ST/LV), (2) long travel to high-volume hospitals (LT/HV). Outcomes were adjusted for clinical, tumor, and treatment characteristics. Results Two thousand five hundred ninety-nine patients met the inclusion criteria. The LT/HV cohort was younger and more often white (p < 0.01). The LT/HV group had more comorbidities, higher tumor grade, and more often radical resections and radiotherapy (all p < 0.05). The ST/LV group underwent significantly more R2 resections (4.4% vs. 2.6%, p = 0.003). Thirty-day mortality was significantly lower in the LT/HV group (1.2% vs. 2.8%, p = 0.0026). Five-year survival was better among the LT/HV group (63% vs. 53%, p < 0.0001). After adjustment, the LT/HV group had a 27% improvement in overall survival (HR 0.73, p = 0.0009). Conclusions This national study suggests that traveling to high-volume centers for the treatment of RPS confers a significant short-term and long-term survival advantage, supporting centralized care for RPS.

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Renaissance of Modified Charlson Comorbidity Index in Prediction of Short- and Long-Term Survival After Liver Transplantation?

Medical Science Monitor ◽

10.12659/msm.914669 ◽

2019 ◽

Vol 25 ◽

pp. 4521-4526

Author(s):

Grzegorz Niewiński ◽

Agata Graczyńska ◽

Szymon Morawiec ◽

Joanna Raszeja-Wyszomirska ◽

Maciej Wójcicki ◽

...

Keyword(s):

Liver Transplantation ◽

Charlson Comorbidity Index ◽

Term Survival ◽

Long Term Survival ◽

Comorbidity Index ◽

Short And Long Term

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Hospital Volume, Margin Status, and Long-Term Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

The American Surgeon ◽

10.1177/000313481207800243 ◽

2012 ◽

Vol 78 (2) ◽

pp. 225-229 ◽

Cited By ~ 21

Author(s):

Marco La Torre ◽

Giuseppe Nigri ◽

Linda Ferrari ◽

Giulia Cosenza ◽

Matteo Ravaioli ◽

...

Keyword(s):

Pancreatic Surgery ◽

Hospital Volume ◽

Survival Rates ◽

High Volume ◽

Margin Status ◽

Negative Margin ◽

Term Survival ◽

Modeling And Analysis ◽

Low Volume

An association between hospital surgical volume and short- and long-term outcomes after pancreatic surgery has been demonstrated. Identification of specific factors contributing to this relationship is difficult. In this study, the authors evaluated if margin status can be identified as a measure of surgical quality, affecting overall survival, as a function of hospital pancreaticoduodenectomy volume. A systematic review of the literature was performed. Two models for analysis were created, dividing the 18 studies identified into quartiles and two quantiles based on the average annual hospital pancreatectomy volume. Regression modeling and analysis of variance were used to find an association between hospital volume, margin status, and survival. Increasing hospital volume was associated with a significantly increased negative margin status rate: 55 per cent for low-volume, 72 per cent for medium-volume, 74.3 per cent for high-volume, and 75.7 per cent for very high-volume centers ( P = 0.008). The negative margin status rates were 64 per cent and 75.1 per cent for volume centers with less and more than 12 pancreaticoduodenectomies/year, respectively ( P = 0.04). Low-volume centers negatively affected both margin positive resection and 5-year survival rates, compared with high-volume centers. Margin status rate after pancreaticoduodenectomy could, therefore, be considered a measure of quality for selection of hospitals dedicated to pancreatic surgery.

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The Volume-Outcome Relationship in Retroperitoneal Soft Tissue Sarcoma: Evidence of Improved Short- and Long-Term Outcomes at High-Volume Institutions

Sarcoma ◽

10.1155/2018/3056562 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 8

Author(s):

Sanjay P. Bagaria ◽

Matthew Neville ◽

Richard J. Gray ◽

Emmanuel Gabriel ◽

Jonathan B. Ashman ◽

...

Keyword(s):

Overall Survival ◽

Care Delivery ◽

National Level ◽

Survival Rates ◽

High Volume ◽

Surgical Mortality ◽

Case Volume ◽

Outcome Relationship ◽

Low Volume

Background. We sought to study the association between RPS case volume and outcomes. Although a relationship has been demonstrated between case volume and patient outcomes in some cancers, such a relationship has not been established for retroperitoneal sarcomas (RPSs). Study Design. The National Cancer Database (NCDB) was queried for patients undergoing treatment for primary RPS diagnosed between 2004 and 2013. Mean annual patient volume for RPS resection was calculated for all hospitals and divided into low volume (<5 cases/year), medium volume (5–10 cases/year), and high volume (>10 cases/year). Risk-adjusted regression analyses were performed to identify predictors of 30-day surgical mortality, R0 margin status, and overall survival (OS). Results. Our study population consisted of 5,407 patients with a median age of 61 years, of whom 47% were male and 3,803 (70%) underwent surgical resection. Absolute 30-day surgical mortality and R0 margin rate following surgery for low-, medium-, and high-volume institutions were 2.4%, 1.3%, and 0.5% (p=0.027) and 68%, 65%, and 82%, (p<0.001), respectively. Five-year overall survival rates for low, medium, and high-volume institutions were 56%, 57%, and 66%, respectively (p<0.001). Patients treated at low-volume institutions had a significantly higher risk of 30-day mortality (adjusted OR = 4.66, 95% CI 2.26–9.63) and long-term mortality (adjusted HR = 1.56, 95% CI 1.16–2.11) compared to high-volume institutions. Conclusion. We demonstrate the existence of a hospital sarcoma service line volume-oncologic outcome relationship for RPS at the national level and provide benchmark data for cancer care delivery systems and policy makers.

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The association between hospital case volume and in-hospital and one-year mortality after hip fracture surgery

The Bone & Joint Journal ◽

10.1302/0301-620x.102b10.bjj-2019-1728.r3 ◽

2020 ◽

Vol 102-B (10) ◽

pp. 1384-1391

Author(s):

Seokha Yoo ◽

Eun Jin Jang ◽

Junwoo Jo ◽

Jun Gi Jo ◽

Seungpyo Nam ◽

...

Keyword(s):

Hip Fracture ◽

Hospital Mortality ◽

High Volume ◽

Case Volume ◽

Hospital Case ◽

Hip Fracture Surgery ◽

Low Volume ◽

One Year ◽

Fracture Surgery ◽

Very High

Aims Hospital case volume is shown to be associated with postoperative outcomes in various types of surgery. However, conflicting results of volume-outcome relationship have been reported in hip fracture surgery. This retrospective cohort study aimed to evaluate the association between hospital case volume and postoperative outcomes in patients who had hip fracture surgery. We hypothesized that higher case volume would be associated with lower risk of in-hospital and one-year mortality after hip fracture surgery. Methods Data for all patients who underwent surgery for hip fracture from January 2008 to December 2016 were extracted from the Korean National Healthcare Insurance Service database. According to mean annual case volume of surgery for hip fracture, hospitals were classified into very low (< 30 cases/year), low (30 to 50 cases/year), intermediate (50 to 100 cases/year), high (100 to 150 cases/year), or very high (> 150 cases/year) groups. The association between hospital case volume and in-hospital mortality or one-year mortality was assessed using the logistic regression model to adjust for age, sex, type of fracture, type of anaesthesia, transfusion, comorbidities, and year of surgery. Results Between January 2008 and December 2016, 269,535 patients underwent hip fracture surgery in 1,567 hospitals in Korea. Compared to hospitals with very high volume, in-hospital mortality rates were significantly higher in those with high volume (odds ratio (OR) 1.10, 95% confidence interval ((CI) 1.02 to 1.17, p = 0.011), low volume (OR 1.22, 95% CI 1.14 to 1.32, p < 0.001), and very low volume (OR 1.25, 95% CI 1.16 to 1.34, p < 0.001). Similarly, hospitals with lower case volume showed higher one-year mortality rates compared to hospitals with very high case volume (low volume group, OR 1.15, 95% CI 1.11 to 1.19, p < 0.001; very low volume group, OR 1.10, 95% CI 1.07 to 1.14, p < 0.001). Conclusion Higher hospital case volume of hip fracture surgery was associated with lower in-hospital mortality and one-year mortality in a dose-response fashion. Cite this article: Bone Joint J 2020;102-B(10):1384–1391.

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High-Volume Hospitals with High-Volume and Low-Volume Surgeons: Is There a “Field Effect” for Pancreaticoduodenectomy?

The American Surgeon ◽

10.1177/000313481608200514 ◽

2016 ◽

Vol 82 (5) ◽

pp. 407-411 ◽

Cited By ~ 3

Author(s):

Thomas W. Wood ◽

Sharona B. Ross ◽

Ty A. Bowman ◽

Amanda Smart ◽

Carrie E. Ryan ◽

...

Keyword(s):

Hospital Mortality ◽

Field Effect ◽

Hospital Volume ◽

Patient Discharge ◽

High Volume ◽

Surgeon Volume ◽

Hospital Charges ◽

Leapfrog Group ◽

Discharge Status ◽

Low Volume

Since the Leapfrog Group established hospital volume criteria for pancreaticoduodenectomy (PD), the importance of surgeon volume versus hospital volume in obtaining superior outcomes has been debated. This study was undertaken to determine whether low-volume surgeons attain the same outcomes after PD as high-volume surgeons at high-volume hospitals. PDs undertaken from 2010 to 2012 were obtained from the Florida Agency for Health Care Administration. High-volume hospitals were identified. Surgeon volumes within were determined; postoperative length of stay (LOS), in-hospital mortality, discharge status, and hospital charges were examined relative to surgeon volume. Six high-volume hospitals were identified. Each hospital had at least one surgeon undertaking ≥ 12 PDs per year and at least one surgeon undertaking < 12 PDs per year. Within these six hospitals, there were 10 “high-volume” surgeons undertaking 714 PDs over the three-year period (average of 24 PDs per surgeon per year), and 33 “low-volume” surgeons undertaking 225 PDs over the three-year period (average of two PDs per surgeon per year). For all surgeons, the frequency with which surgeons undertook PD did not predict LOS, in-hospital mortality, discharge status, or hospital charges. At the six high-volume hospitals examined from 2010 to 2012, low-volume surgeons undertaking PD did not have different patient outcomes from their high-volume counterparts with respect to patient LOS, in-hospital mortality, patient discharge status, or hospital charges. Although the discussion of volume for complex operations has shifted toward surgeon volume, hospital volume must remain part of the discussion as there seems to be a hospital “field effect.”

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