A new Johns Hopkins research suggests that older, sicker heart-transplant recipients are significantly more likely to be alive a year after their operations if they have their transplants at hospitals that do a large number of them annually. These patients fare less well at low-volume centers, the research shows.
The findings, to be presented May 9 at the American Association of Thoracic Surgeons' annual meeting in Philadelphia, add more support to the notion that patients do better when treated at medical centers that handle a higher number of cases similar to theirs.
The findings, to be presented May 9 at the American Association of Thoracic Surgeons' annual meeting in Philadelphia, add more support to the notion that patients do better when treated at medical centers that handle a higher number of cases similar to theirs.
"There's growing evidence throughout medicine and surgery that the volume of cases done at a given medical center has an impact on outcomes," says George J. Arnaoutakis, M.D., a general surgery resident at the Johns Hopkins University School of Medicine and the study's leader. "Transplant teams more familiar with a procedure do a better job than those that only do a handful each year."
They also ranked the 141 hospitals where the transplants took place into low-, medium- and high-volume centers. Low-volume centers did fewer than six heart transplants a year, while high-volume centers performed more than 15 annually. Just 5.4 percent of heart transplants took place at low-volume centers over that period, while more than 67 percent were done at high-volume centers.
High-risk patients transplanted at low-volume centers had a 67 percent increased risk of death after one year compared with high-risk patients transplanted at high-volume centers. Severity of condition alone did not account for the difference, which diminished among low-risk patients.
"Patients at high risk of mortality should probably only be transplanted at high-volume centers," Arnaoutakis says.
Arnaoutakis cautions that the findings should not be seen as an indictment of the training and skill of surgeons at low-volume centers. Rather, he says, the systems and infrastructure of a center doing few heart transplants are most likely a bigger factor.
"There are certain processes that may be better performed at regional centers of excellence doing more of a certain procedure," he says. "People talk about it with airline pilots — only at 10,000 hours of flying are they considered expert at flying. The experience of a center can be discussed in similar terms."
Nurses at a high-volume center, for example, may be quicker to recognize complications and intervene earlier, he says. Operating room teams might be better prepared to handle a transplant that occurs in the middle of the night.
"The more you do it, the better you become at doing it," Arnaoutakis says.
Source: Eurekalert
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