Relationship between provider volume and outcomes for orthotopic liver transplantation.
BACKGROUND
Recent data suggests that the previously demonstrable relationship between hospital volume and outcomes for liver transplant procedures may no longer exist. Furthermore, to our knowledge, no study has been published examining whether individual surgeon volume is associated with outcomes in liver transplantation.


METHODS
The Nationwide Inpatient Sample database was used to obtain early clinical outcome and resource utilization data for liver transplant procedures performed in the USA from 1988 through 2003. The relationship between surgeon and hospital volume and early clinical outcomes was analyzed with and without adjustment for certain confounding variables such as patient age and presence of co-morbid disease.


RESULTS
The in-hospital mortality rate, major postoperative complication rate, and length of hospital stay after liver transplantation did not differ significantly based on hospital procedural volume. These outcome variables did, however, exhibit a statistically significant inverse relationship with individual surgeon volume of liver transplant procedures. A significant relationship between procedure volume and outcomes for liver transplantation cannot be demonstrated at the level of transplant center, but does appear to exist at the level of the individual transplant center.


CONCLUSIONS
Minimal volume requirements for individual liver transplant surgeons may be justified, pending validation of this volume-outcomes relationship using a clinical data source.
Scarborough
John E
JE
Department of Surgery, Division of General Surgery, Duke University Medical Center, Durham, NC 27710, USA. scarb005@mc.duke.edu
Pietrobon
Ricardo
R
Tuttle-Newhall
Janet E
JE
Marroquin
Carlos E
CE
Collins
Bradley H
BH
Desai
Dev M
DM
Kuo
Paul C
PC
Pappas
Theodore N
TN
D000328:Adult; D000367:Age Factors; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D006085:Graft Survival; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007902:Length of Stay; D016031:Liver Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries; D012044:Regression Analysis; D040841:Resource Allocation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data* / Q000639:trends; D014182:Transplantation, Autologous / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome