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Previous Volume 341:2049-2053 December 30, 1999 Number 27 Next

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ABSTRACT

Background For many complex surgical procedures there is an association between a low volume of procedures and an increased risk of death for the patients who undergo the procedures.

Methods We examined the effect of the volume of procedures at transplantation centers on the risk of death after liver transplantation. We analyzed all liver transplantations performed in the United States between October 1, 1987, and April 30, 1994. Because the results for 1987 to 1991 were largely similar to those from 1992 to 1994, we focused on the more recent period.

Results Between January 1, 1992, and April 30, 1994, 47 centers performed 20 or fewer liver transplantations each per year (total, 837 transplantations) and were designated low-volume centers, and 52 centers performed more than 20 transplantations each per year (total, 6526) and were designated high-volume centers. The one-year mortality rate for the low-volume centers was 25.9 percent, as compared with 20.0 percent for the high-volume centers. Thirteen centers, all of which had low volumes, had one-year mortality rates of more than 40 percent. Low-volume centers that were affiliated with high-volume centers, such as pediatric transplantation programs, had results similar to those of the high-volume centers. The one-year mortality rate at unaffiliated low-volume centers was 28.3 percent, as compared with a rate of 20.1 percent for the group of all high-volume centers plus affiliated low-volume centers (P<0.001).

Conclusions As a group, liver-transplantation centers in the United States that perform 20 or fewer transplantations per year have mortality rates that are significantly higher than those at centers that perform more than 20 transplantations per year. Information regarding the outcome of liver transplantation at transplantation centers should be made widely available to the public.

Source Information

From the United Network for Organ Sharing, Richmond, Va. (E.B.E., M.A.M.); the University of California at San Francisco, San Francisco (J.P.R.); University Hospitals of Cleveland, Cleveland (J.A.S.); and the University of Iowa College of Medicine, Iowa City (L.G.H.).

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Volume of Procedures at Transplantation Centers and Mortality after Liver Transplantation
Laks M. P., Cohen T., Hack R., Hillebrand D. J., Concepcion W., Bettschart V., Burnand B., Mosimann F., Edwards E. B., Roberts J. P., Hunsicker L. G.
Extract | Full Text  
N Engl J Med 2000; 342:1527-1528, May 18, 2000. Correspondence

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