How small is too small? A systematic review of center volume and outcome after cardiac transplantation

Pettit, S.J., Jhund, P.S. , Hawkins, N.M., Gardner, R.S., Haj-Yahia, S., McMurray, J.J.V. and Petrie, M.C. (2012) How small is too small? A systematic review of center volume and outcome after cardiac transplantation. Circulation: Cardiovascular Quality and Outcomes, 5(6), pp. 783-790. (doi: 10.1161/CIRCOUTCOMES.112.966630)

Abstract

Background—The aim of this study was to assess the relationship between the volume of cardiac transplantation procedures performed in a center and the outcome after cardiac transplantation. Methods and Results—PubMed, Embase, and the Cochrane library were searched for articles on the volume–outcome relationship in cardiac transplantation. Ten studies were identified, and all adopted a different approach to data analysis and varied in adjustment for baseline characteristics. The number of patients in each study ranged from 798 to 14401, and observed 1-year mortality ranged from 12.6% to 34%. There was no association between the continuous variables of center volume and observed mortality. There was a weak association between the continuous variables of center volume and adjusted mortality up to 1 year and a stronger association at 5 years. When centers were grouped in volume categories, low-volume centers had the highest adjusted mortality, intermediate-volume centers had lower adjusted mortality, and high-volume centers had the lowest adjusted mortality but were not significantly better than intermediate-volume centers. Category limits were arbitrary and varied between studies. Conclusions—There is a relationship between center volume and mortality in heart transplantation. The existence of a minimum acceptable center volume or threshold is unproven. However, a level of 10 to 12 heart transplants per year corresponds to the upper limit of low-volume categories that may have relatively higher mortality. It is not known whether outcomes for patients treated in low-volume transplant centers would be improved by reorganizing centers to ensure volumes in excess of 10 to 12 heart transplants per year.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Jhund, Professor Pardeep and Petrie, Professor Mark and McMurray, Professor John and Gardner, Professor Roy
• Authors: Pettit, S.J., Jhund, P.S., Hawkins, N.M., Gardner, R.S., Haj-Yahia, S., McMurray, J.J.V., and Petrie, M.C.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Circulation: Cardiovascular Quality and Outcomes
• Publisher: American Heart Association
• ISSN: 1941-7713
• Published Online: 06 November 2012
• Copyright Holders: Copyright © 2012 American Heart Association
• First Published: First published in Circulation: Cardiovascular Quality and Outcomes 5(6):783-790
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher