Centre volume and resource consumption in liver transplantation

Area of Science:

• Transplant Surgery
• Health Services Research
• Health Economics

Background:

• Previous studies using SRTR/UNOS data indicate that increased liver transplant center volume correlates with improved graft and patient survival.
• The impact of center volume on quality, utilization, and cost in the current healthcare reform and pay-for-performance landscape remains unclear.

Purpose of the Study:

• To investigate the relationship between liver transplant center volume and key quality, utilization, and cost metrics.
• To evaluate the efficiency of hospital resource use and patient outcomes across different center volume tertiles.

Main Methods:

• Utilized the UHC database from 2009-2010, identifying 63 liver transplant centers.
• Centers were stratified into tertiles based on annual case volume and adjusted for severity of illness (SOI).
• Key utilization endpoints included hospital and ICU length of stay (LOS), cost, and in-hospital mortality.

Main Results:

• A total of 5130 liver transplants were analyzed.
• High-volume centers (HVC) exhibited improved mortality rates (2.9%) compared to low-volume centers (LVC) (3.4%).
• HVC demonstrated significantly shorter median LOS (9 days vs. 10 days), ICU LOS (2 days vs. 3 days), and lower direct costs ($90,946 vs. $98,055) than LVC and MVC, even after adjusting for SOI.

Conclusions:

• Increased liver transplant center volume is associated with improved long-term post-transplant outcomes.
• Higher center volume leads to more efficient hospital resource utilization, including reduced costs.
• These findings can inform decision-making and optimize pay-for-performance models in liver transplantation.