Institutional Case-Volume and Mortality After Heart Transplantation

Nam, Karam; Jang, Eun Jin; Kim, Ga Hee; Lee, Hannah; Kim, Dal Ho; Ryu, Ho Geol

doi:10.1536/ihj.18-428

Cited by 13 publications

(15 citation statements)

References 33 publications

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“…Numerous studies in cardiac surgery have shown that the risk of postoperative death was lower in high volume centers compared to lower volume centers including coronary artery bypass grafting [7], aortic valve replacement [17], mitral valve procedures [18], aortic root replacement [19], and heart transplantation [2]. A similar volume-outcome relationship have been reported in urgent or emergent abdominal aorta surgery [16,20], but the relationship was between surgeon case volume, not institutional case volume, and patients outcome.…”

Section: Discussionmentioning

confidence: 72%

“…The association between case volume and patient outcome in complex surgical procedures have been reported consistently [1][2][3]. The mechanism behind the relationship is unclear but proposed explanations include accumulated experience at the individual or institutional level and preferential referral, which in turn may lead to increased case volume and improved outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Association between institutional case volume and mortality following thoracic aorta replacement: a nationwide Korean cohort study

Nam

Jang

et al. 2020

J Cardiothorac Surg

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Background: The inverse relationship between case volume and postoperative mortality following high-risk surgical procedures have been reported. Thoracic aorta surgery is associated with one of the highest postoperative mortality. The relationship between institutional case volume and postoperative mortality in patients undergoing thoracic aorta replacement surgery was evaluated. Methods: All thoracic aorta replacement surgeries performed in Korea between 2009 and 2016 in adult patients were analyzed using an administrative database. Hospitals were divided into low (< 30 cases/year), medium (30-60 cases/year), or high (> 60 cases/year) volume centers depending on the annual average number of thoracic aorta replacement surgeries performed. The impact of case volume on in-hospital mortality was assessed using the logistic regression. Results: Across 83 hospitals, 4867 cases of thoracic aorta replacement were performed. In-hospital mortality was 8.6% (191/2222), 10.7% (77/717), and 21.9% (422/1928) in high, medium, and low volume centers, respectively. The adjusted risk of in-hospital mortality was significantly higher in medium (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.16-2.11, P = 0.004) and low volume centers (OR, 3.12; 95% CI, 2.54-3.85, P < 0.001) compared to high volume centers. Conclusions: Patients who had underwent thoracic aorta replacement surgery in lower volume centers had increased risk of in-hospital mortality after surgery compared to those in higher volume centers. Our results may provide the basis for minimum case volume requirement or regionalization in thoracic aorta replacement surgery for optimal patient outcome.

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Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Association between institutional case volume and mortality following thoracic aorta replacement: a nationwide Korean cohort study

Nam

Jang

et al. 2020

J Cardiothorac Surg

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“…Case-volume effect on patient outcome has been demonstrated mainly in high-risk procedures such as major cancer resections, cardiovascular procedures, and heart transplantation [7][8][9][10] while relatively simple surgical procedures such as laparoscopic cholecystectomy showed no signi cant case-volume effect [25,26]. Experienced surgical teams, nurses, and anesthesiologists are more likely to be prepared to optimally manage anticipated and unanticipated complications that may occur during high-risk surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

“…The impact of surgical volume on patient outcome has been widely studied for complex surgical procedures with signi cant postoperative morbidity such as major cancer resections, cardiovascular procedures, and solid organ transplantation [7][8][9][10]. The 0 has also been suggested for ovarian cancer surgery [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Hospital case-volume and mortality after ovarian cancer surgery: a population-based retrospective cohort study

Kim

Joo

et al. 2021

Preprint

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Background The goal of ovarian cancer surgery has recently shifted from optimal cytoreduction to more complete resection. This study attempted to reassess and update the association between surgical case-volume and both in-hospital and long-term mortality after ovarian cancer surgery using recent data. Methods Data from all adult patients who underwent ovarian cancer surgery in Korea between 2004 and 2017 were obtained from the database of Korean National Health Insurance Service. Hospitals were categorized by average annual number of surgeries considering overall distribution of case-volume. Postoperative in-hospital and 1, 3, 5-year mortality were analyzed using logistic regression. Results During the study period, 23,487 ovarian cancer surgeries were performed in 354 hospitals. High-, medium-, and low-volume centers were defined as > 100 cases/year, 30–100 cases/year, and < 30 cases/year, respectively. In-hospital mortality was significantly higher in medium-volume (1.63%; adjusted odds ratio, 2.28; confidence interval, 1.64–3.17; P < 0.001) and low-volume (1.62%; adjusted odds ratio; 2.12; confidence interval, 1.55–2.90; P < 0.001) centers compared to high-volume centers (1.13%). In addition, 1-year mortality after ovarian cancer surgery was 6.26%, 7.07%, and 8.06% for high-volume, medium-volume, and low-volume centers, respectively, and the differences among the groups were significant. However, case-volume effect was not apparent in 3- and 5-year mortality after ovarian cancer surgery. Conclusions Case-volume effect was observed for in-hospital and 1-year mortality after ovarian cancer surgery while no clear association was found between the case-volume and 3- or 5-year mortality.

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Section: Introductionmentioning

confidence: 99%

Association between institutional case volume and mortality following thoracic aorta replacement: A nationwide Korean cohort study

Nam

Jang

et al. 2020

Preprint

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Abstract Background The inverse relationship between case volume and postoperative mortality following high-risk surgical procedures have been reported. Thoracic aorta surgery is associated with one of the highest postoperative mortality. The relationship between institutional case volume and postoperative mortality in patients undergoing thoracic aorta replacement surgery was evaluated. Methods All thoracic aorta replacement surgeries performed in Korea between 2009 and 2016 in adult patients were analyzed using an administrative database. Hospitals were divided into low (<30 cases/year), medium (30–60 cases/year), or high (>60 cases/year) volume centers depending on the annual average number of thoracic aorta replacement surgeries performed. The impact of case volume on in-hospital mortality was assessed using the logistic regression. Results Across 83 hospitals, 4867 cases of thoracic aorta replacement were performed. In-hospital mortality was 8.6% (191/2222), 10.7% (77/717), and 21.9% (422/1928) in high, medium, and low volume centers, respectively. The adjusted risk of in-hospital mortality was significantly higher in medium (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.16–2.11, P = 0.004) and low volume centers (OR, 3.12; 95% CI, 2.54–3.85, P <0.001) compared to high volume centers. Conclusions Patients who had underwent thoracic aorta replacement surgery in lower volume centers had increased risk of in-hospital mortality after surgery compared to those in higher volume centers. Our results may provide the basis for minimum case volume requirement or regionalization in thoracic aorta replacement surgery for optimal patient outcome.

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Institutional Case-Volume and Mortality After Heart Transplantation

Cited by 13 publications

References 33 publications

Association between institutional case volume and mortality following thoracic aorta replacement: a nationwide Korean cohort study

Association between institutional case volume and mortality following thoracic aorta replacement: a nationwide Korean cohort study

Hospital case-volume and mortality after ovarian cancer surgery: a population-based retrospective cohort study

Association between institutional case volume and mortality following thoracic aorta replacement: A nationwide Korean cohort study

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