Increased short- and long-term mortality at low-volume pediatric heart transplant centers: Should minimum standards be set?: Retrospective data analysis

Ryan R Davies, Mark J. Russo, Kimberly N. Hong, Seema Mital, Ralph S. Mosca, Jan M. Quaegebeur, Jonathan M. Chen

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective: The relationship between volume and outcome in many complex surgical procedures is well established. Background: No published data has examined this relationship in pediatric cardiac transplantation, but low-volume adult heart transplant programs seem to have higher early mortality. Methods: The United Network for Organ Sharing (UNOS) provided centerspecific data for the 4647 transplants performed on patients younger than 19 years old, 1992 to 2007. Patients were stratified into 3 groups based on the volume of transplants performed in the previous 5 years at that center: low [<19 transplants, n = 1135 (24.4%)], medium [19-62 transplants, n = 2321 (50.0%)], and high [=63 transplants, n= 1191 (25.6%)]. A logistic regression model for postoperative mortality was developed and observed-to-expected (O:E) mortality rates calculated for each group. Results: Unadjusted long-term survival decreased with decreasing center volume (P<0.0001).Observed postoperative mortalitywas higher than expected at low-volume centers [O:E ratio 1.39, 95% confidence interval (CI) 1.05- 1.83]. At low volume centers, high-risk patients (1.34, 0.85-2.12)-especially patients 1 year old or younger (1.60, 1.07-2.40) or those with congenital heart disease (1.36, 0.94-1.96)-did poorly, but those at high-volume centers did well (congenital heart disease: 0.90, 0.36-1.26; age<1 year: 0.75, 0.51-1.09). Similar results were obtained in the subset of patients transplanted after 1996. In multivariate logistic regression modeling, transplantation at a low-volume center was associated with an odds ratio for postoperative mortality of 1.60 (95% CI, 1.14-2.24); transplantation at a medium volume center had an odds ratio of 1.24 (95% CI, 0.92-1.66). Conclusion: The volume of transplants performed at any one center has a significant impact on outcomes. Regionalization of care is one option for improving outcomes in pediatric cardiac transplantation.

Original languageEnglish (US)
Pages (from-to)393-401
Number of pages9
JournalAnnals of Surgery
Volume253
Issue number2
DOIs
StatePublished - Feb 1 2011

Fingerprint

Cardiac Volume
Pediatrics
Transplants
Mortality
Logistic Models
Confidence Intervals
Heart Transplantation
Heart Diseases
Transplantation
Odds Ratio
Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Increased short- and long-term mortality at low-volume pediatric heart transplant centers : Should minimum standards be set?: Retrospective data analysis. / Davies, Ryan R; Russo, Mark J.; Hong, Kimberly N.; Mital, Seema; Mosca, Ralph S.; Quaegebeur, Jan M.; Chen, Jonathan M.

In: Annals of Surgery, Vol. 253, No. 2, 01.02.2011, p. 393-401.

Research output: Contribution to journalArticle

Davies, Ryan R ; Russo, Mark J. ; Hong, Kimberly N. ; Mital, Seema ; Mosca, Ralph S. ; Quaegebeur, Jan M. ; Chen, Jonathan M. / Increased short- and long-term mortality at low-volume pediatric heart transplant centers : Should minimum standards be set?: Retrospective data analysis. In: Annals of Surgery. 2011 ; Vol. 253, No. 2. pp. 393-401.
@article{54b6005163e145aabe0cb1bfbfb5d8cd,
title = "Increased short- and long-term mortality at low-volume pediatric heart transplant centers: Should minimum standards be set?: Retrospective data analysis",
abstract = "Objective: The relationship between volume and outcome in many complex surgical procedures is well established. Background: No published data has examined this relationship in pediatric cardiac transplantation, but low-volume adult heart transplant programs seem to have higher early mortality. Methods: The United Network for Organ Sharing (UNOS) provided centerspecific data for the 4647 transplants performed on patients younger than 19 years old, 1992 to 2007. Patients were stratified into 3 groups based on the volume of transplants performed in the previous 5 years at that center: low [<19 transplants, n = 1135 (24.4{\%})], medium [19-62 transplants, n = 2321 (50.0{\%})], and high [=63 transplants, n= 1191 (25.6{\%})]. A logistic regression model for postoperative mortality was developed and observed-to-expected (O:E) mortality rates calculated for each group. Results: Unadjusted long-term survival decreased with decreasing center volume (P<0.0001).Observed postoperative mortalitywas higher than expected at low-volume centers [O:E ratio 1.39, 95{\%} confidence interval (CI) 1.05- 1.83]. At low volume centers, high-risk patients (1.34, 0.85-2.12)-especially patients 1 year old or younger (1.60, 1.07-2.40) or those with congenital heart disease (1.36, 0.94-1.96)-did poorly, but those at high-volume centers did well (congenital heart disease: 0.90, 0.36-1.26; age<1 year: 0.75, 0.51-1.09). Similar results were obtained in the subset of patients transplanted after 1996. In multivariate logistic regression modeling, transplantation at a low-volume center was associated with an odds ratio for postoperative mortality of 1.60 (95{\%} CI, 1.14-2.24); transplantation at a medium volume center had an odds ratio of 1.24 (95{\%} CI, 0.92-1.66). Conclusion: The volume of transplants performed at any one center has a significant impact on outcomes. Regionalization of care is one option for improving outcomes in pediatric cardiac transplantation.",
author = "Davies, {Ryan R} and Russo, {Mark J.} and Hong, {Kimberly N.} and Seema Mital and Mosca, {Ralph S.} and Quaegebeur, {Jan M.} and Chen, {Jonathan M.}",
year = "2011",
month = "2",
day = "1",
doi = "10.1097/SLA.0b013e31820700cc",
language = "English (US)",
volume = "253",
pages = "393--401",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Increased short- and long-term mortality at low-volume pediatric heart transplant centers

T2 - Should minimum standards be set?: Retrospective data analysis

AU - Davies, Ryan R

AU - Russo, Mark J.

AU - Hong, Kimberly N.

AU - Mital, Seema

AU - Mosca, Ralph S.

AU - Quaegebeur, Jan M.

AU - Chen, Jonathan M.

PY - 2011/2/1

Y1 - 2011/2/1

N2 - Objective: The relationship between volume and outcome in many complex surgical procedures is well established. Background: No published data has examined this relationship in pediatric cardiac transplantation, but low-volume adult heart transplant programs seem to have higher early mortality. Methods: The United Network for Organ Sharing (UNOS) provided centerspecific data for the 4647 transplants performed on patients younger than 19 years old, 1992 to 2007. Patients were stratified into 3 groups based on the volume of transplants performed in the previous 5 years at that center: low [<19 transplants, n = 1135 (24.4%)], medium [19-62 transplants, n = 2321 (50.0%)], and high [=63 transplants, n= 1191 (25.6%)]. A logistic regression model for postoperative mortality was developed and observed-to-expected (O:E) mortality rates calculated for each group. Results: Unadjusted long-term survival decreased with decreasing center volume (P<0.0001).Observed postoperative mortalitywas higher than expected at low-volume centers [O:E ratio 1.39, 95% confidence interval (CI) 1.05- 1.83]. At low volume centers, high-risk patients (1.34, 0.85-2.12)-especially patients 1 year old or younger (1.60, 1.07-2.40) or those with congenital heart disease (1.36, 0.94-1.96)-did poorly, but those at high-volume centers did well (congenital heart disease: 0.90, 0.36-1.26; age<1 year: 0.75, 0.51-1.09). Similar results were obtained in the subset of patients transplanted after 1996. In multivariate logistic regression modeling, transplantation at a low-volume center was associated with an odds ratio for postoperative mortality of 1.60 (95% CI, 1.14-2.24); transplantation at a medium volume center had an odds ratio of 1.24 (95% CI, 0.92-1.66). Conclusion: The volume of transplants performed at any one center has a significant impact on outcomes. Regionalization of care is one option for improving outcomes in pediatric cardiac transplantation.

AB - Objective: The relationship between volume and outcome in many complex surgical procedures is well established. Background: No published data has examined this relationship in pediatric cardiac transplantation, but low-volume adult heart transplant programs seem to have higher early mortality. Methods: The United Network for Organ Sharing (UNOS) provided centerspecific data for the 4647 transplants performed on patients younger than 19 years old, 1992 to 2007. Patients were stratified into 3 groups based on the volume of transplants performed in the previous 5 years at that center: low [<19 transplants, n = 1135 (24.4%)], medium [19-62 transplants, n = 2321 (50.0%)], and high [=63 transplants, n= 1191 (25.6%)]. A logistic regression model for postoperative mortality was developed and observed-to-expected (O:E) mortality rates calculated for each group. Results: Unadjusted long-term survival decreased with decreasing center volume (P<0.0001).Observed postoperative mortalitywas higher than expected at low-volume centers [O:E ratio 1.39, 95% confidence interval (CI) 1.05- 1.83]. At low volume centers, high-risk patients (1.34, 0.85-2.12)-especially patients 1 year old or younger (1.60, 1.07-2.40) or those with congenital heart disease (1.36, 0.94-1.96)-did poorly, but those at high-volume centers did well (congenital heart disease: 0.90, 0.36-1.26; age<1 year: 0.75, 0.51-1.09). Similar results were obtained in the subset of patients transplanted after 1996. In multivariate logistic regression modeling, transplantation at a low-volume center was associated with an odds ratio for postoperative mortality of 1.60 (95% CI, 1.14-2.24); transplantation at a medium volume center had an odds ratio of 1.24 (95% CI, 0.92-1.66). Conclusion: The volume of transplants performed at any one center has a significant impact on outcomes. Regionalization of care is one option for improving outcomes in pediatric cardiac transplantation.

UR - http://www.scopus.com/inward/record.url?scp=79151473566&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79151473566&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e31820700cc

DO - 10.1097/SLA.0b013e31820700cc

M3 - Article

C2 - 21183849

AN - SCOPUS:79151473566

VL - 253

SP - 393

EP - 401

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 2

ER -