Institutional Case-Volume and Mortality After Heart Transplantation

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Rat Heterotopic Abdominal Heart/Single-lung Transplantation in a Volume-loaded Configuration
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Rat Heterotopic Abdominal Heart/Single-lung Transplantation in a Volume-loaded Configuration

Published on: May 29, 2015

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Karam Nam1, Eun Jin Jang2, Ga Hee Kim3

  • 1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine.

International Heart Journal
|April 26, 2019
PubMed

Insights

Lower heart transplant (HT) case volumes in hospitals correlate with higher in-hospital and long-term mortality. This suggests a need for minimum volume requirements to improve patient outcomes and resource allocation in HT procedures.

Area of Science:

  • Cardiology
  • Transplantation Surgery
  • Health Services Research

Background:

  • A known inverse relationship exists between institutional case-volume and mortality for complex, high-risk surgeries.
  • Understanding this relationship is crucial for optimizing patient outcomes in heart transplantation (HT).

Purpose of the Study:

  • To investigate the impact of hospital heart transplantation (HT) case-volume on patient outcomes within the Korean population.
  • To analyze the association between institutional HT volume and both in-hospital and long-term mortality.

Main Methods:

  • Analysis of adult HT procedures in Korea from 2007-2016 using National Health Insurance Service data.
  • Hospitals were categorized into low-, medium-, and high-volume centers based on HT frequency.
  • Statistical analysis of in-hospital and long-term mortality rates in relation to hospital volume.

Main Results:

  • A total of 833 adult HTs were performed across 17 centers.
  • In-hospital mortality rates were 3.7% (high-volume), 10.1% (medium-volume), and 18.6% (low-volume).
  • Lower volume centers (medium and low) demonstrated significantly increased in-hospital mortality risk and worse long-term survival up to 10 years.

Conclusions:

  • Lower institutional case-volume is significantly associated with increased in-hospital and long-term mortality after heart transplantation (HT).
  • Implementing a minimum case-volume mandate for HT-performing hospitals may be necessary to enhance patient outcomes and optimize resource allocation.

Keywords:
Outcome

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