title: Centre volume and resource consumption in liver transplantation.
abstract: BACKGROUND
  Using SRTR/UNOS data, it has previously been shown that increased liver transplant centre volume improves graft and patient survival. In the current era of health care reform and pay for performance, the effects of centre volume on quality, utilization and cost are unknown.
  
  
  METHODS
  Using the UHC database (2009-2010), 63 liver transplant centres were identified that were organized into tertiles based on annual centre case volume and stratified by severity of illness (SOI). Utilization endpoints included hospital and intensive care unit (ICU) length of stay (LOS), cost and in-hospital mortality.
  
  
  RESULTS
  In all, 5130 transplants were identified. Mortality was improved at high volume centres (HVC) vs. low volume centres (LVC), 2.9 vs. 3.4%, respectively. HVC had a lower median LOS than LVC (9 vs. 10 days, P < 0.0001), shorter median ICU stay than LVC and medium volume centres (MVC) (2 vs. 3 and 3 days, respectively, P < 0.0001) and lower direct costs than LVC and MVC ($90,946 vs. $98,055 and $101,014, respectively, P < 0.0001); this effect persisted when adjusted for severity of illness.
  
  
  CONCLUSIONS
  This UHC-based cohort shows that increased centre volume results in improved long-term post-liver transplant outcomes and more efficient use of hospital resources thereby lowering the cost. A better understanding of these mechanisms can lead to informed decisions and optimization of the pay for performance model in liver transplantation.
authors: Department of Surgery Outcomes Analysis & Research, University of Massachusetts, Worcester, USA.
authors: Christopher W
authors: CW
authors: Macomber
authors: Joshua J
authors: JJ
authors: Shaw
authors: Heena
authors: H
authors: Santry
authors: Reza F
authors: RF
authors: Saidi
authors: Nicolas
authors: N
authors: Jabbour
authors: Jennifer F
authors: JF
authors: Tseng
authors: Adel
authors: A
authors: Bozorgzadeh
authors: Shimul A
authors: SA
authors: Shah
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult