Centre volume and resource consumption in liver transplantation

Macomber, Christopher W.; Shaw, Joshua; Santry, Heena P.; Saidi, Reza F.; Jabbour, Nicolas; Tseng, Jennifer F.; Bozorgzadeh, Adel; Shah, Shimul A.

doi:10.1111/j.1477-2574.2012.00503.x

Cited by 61 publications

(57 citation statements)

References 29 publications

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“…Eight studies could not be included in the fi nal analyses because they had insuffi cient data to calculate OR. 19,21,41,44,51,53,54,56 Th e results of these studies are presented in Table 2 . Among the remaining studies (n 5 37), the consistency of the relationship varied considerably across diagnoses.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…16,18,19 Seven clinical conditions were covered: respiratory diagnoses including mechanical ventilation, acute respiratory failure, and pneumonia (13 studies) 15,16,[20][21][22][23][24][25][26][27][28][29][30] ; cardiovascular diagnoses including cardiac arrest and cardiogenic shock (eight studies) [31][32][33][34][35][36][37][38] ; sepsis (six studies) [39][40][41][42][43][44] ; neurologic diagnoses (three studies) 15,45,46 ; hepato-GI diagnoses (three studies) 15,47,48 ; renal diagnoses (three studies) 17,49 ; and postoperative conditions including pancreatectomy, hepatectomy, esophagectomy, major vascular surgery (seven studies). [50][51][52][53][54][55][56] The majority of studies (n 5 24, 52%) used clinical databases rather than administrative databases. Th e most common unit of analysis used was hospital volume (n 5 25, 54%), followed...…”

Section: Study Characteristicsmentioning

confidence: 99%

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The Volume-Outcome Relationship in Critical Care

Nguyen

Wallace

Yordanov

et al. 2015

Chest

119

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, MEDLINE and EMBASE were searched for studies assessing the relationship between admission volume and clinical outcomes in critical illness. Bibliographies were reviewed to identify other articles of interest, and experts were contacted about missing or unpublished studies. Of 127 studies reviewed, 46 met inclusion criteria, covering seven clinical conditions. Two investigators independently reviewed each article using a standardized form to abstract information on key study characteristics and results. 05-8.30]) were more likely to benefi t from admission to higher-volume centers compared with lower-volume centers. Studies that controlled for ICU or hospital organizational factors were less likely to fi nd a signifi cant volume-outcome relationship than studies that did not control for these factors. CONCLUSIONS:Critically ill patients generally benefi t from care in high-volume centers, with more substantial benefi ts in selected high-risk conditions. Th is relationship may in part be mediated by specifi c ICU and hospital organizational factors.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

The Volume-Outcome Relationship in Critical Care

Nguyen

Wallace

Yordanov

et al. 2015

Chest

119

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“…Previous kidney and liver transplant studies demonstrate significant variation in transplant admission cost and EHR among centers, with transplant center volume contributing to variation (4)(5)(6)(7)(8)(9)(10)(11)(12). For instance, concerning liver transplants, highvolume centers have lower transplant admission cost than intermediate-and low-volume centers (5).…”

mentioning

confidence: 99%

Effect of Transplant Center Volume on Cost and Readmissions in Medicare Lung Transplant Recipients

Mooney

Weill

Boyd³

et al. 2016

Annals ATS

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Rationale: Although lung transplant recipient survival is better at higher volume centers, the effect of center volume on admission cost and early hospital readmission is unknown.Objectives: To understand the association between transplant center volume and recipient risk-adjusted transplant admission cost, in-hospital mortality, and early hospital readmission in lung transplant recipients. [SD, 6$123,316]; median, $95,234; IQR, $83,052-$152,149) centers (P , 0.0001). After adjusting for recipient health risk, low-volume centers had an 11.66% greater transplant admission cost (P = 0.040), a 41% greater risk for in-hospital mortality (P = 0.015), and a 14% greater risk for early hospital readmission (P = 0.033) compared with high-volume centers. There was no significant difference in transplant cost, in-hospital mortality, or early hospital readmission between intermediate-and high-volume centers. MethodsConclusions: Lung transplant admission cost, in-hospital mortality, and early hospital readmission rate are lower at highvolume centers compared with low-volume centers.

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“…192 Another earlier study found that outcomes were better in patients transplanted in centers performing more than 20 transplants/year versus less than 20 transplants/year, whereas, a study by Nijboer et al 193,194 did not find a clear correlation between center activity and outcomes in 24 liver transplant units in Germany. In a similar US-based study, Macomber et al 195 found lower mortality rates in higher-volume centers, with lower median length of hospital and intensive care unit stay and lower direct costs. Others have failed to demonstrate an effect of volume.…”

Section: Provision Of Transplant Unitsmentioning

confidence: 90%