title: The effect of center volume on the incidence of postoperative complications and their impact on survival after lung transplantation.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effect of center volume on the incidence of postoperative complications and their impact on survival after lung transplantation (LTx).
  
  
  METHODS
  United Network for Organ Sharing data were used to identify adult patients undergoing LTx between 1999 and 2009. Center volume was modeled as both a continuous and a categorical variable. Postoperative complications included infection, rejection, stroke, reoperation, and renal failure requiring dialysis. Multivariable Cox regression and Kaplan-Meier analyses were conducted after stratification on the basis of center volume and type of complication.
  
  
  RESULTS
  A total of 12,565 LTx recipients were included in the study. Overall rates of postoperative complications were 5.4% for renal failure requiring dialysis, 1.9% for stroke, 19.9% for reoperation, 42.8% for infection, and 10.0% for rejection. High volume centers did not have significantly reduced rates of postoperative complications. Risk-adjusted multivariable Cox analysis demonstrated that in patients with a complication, low volume center was a significant risk factor for increased 90-day, 1-year, and 5-year mortality. Kaplan-Meier analyses similarly demonstrated reduced posttransplant survival in lower volume centers, a finding that persisted after stratification based on individual complication type except for stroke.
  
  
  CONCLUSIONS
  Although high volume centers do not have significantly lower incidences of individual postoperative complications after LTx, they are best able to minimize the adverse effects of these complications on short- and long-term survival. These data suggest that identifying and implementing the institutional practices that lead to better management of postoperative complications after LTx in high volume centers may be prudent to improving outcomes in lower volume hospitals.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
authors.forename: Arman
authors.initials: A
authors.lastname: Kilic
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: George
authors.forename: Claude A
authors.initials: CA
authors.lastname: Beaty
authors.forename: Christian A
authors.initials: CA
authors.lastname: Merlo
authors.forename: John V
authors.initials: JV
authors.lastname: Conte
authors.forename: Ashish S
authors.initials: AS
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality* / Q000628:therapy; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology