title: Association of hospital procedure volume with post-transplant survival for allogeneic bone marrow transplantation.
abstract: OBJECTIVE
  To examine the association between hospital procedure volume and treatment outcomes following allogeneic bone marrow transplantation (allo-BMT).
  
  
  METHODS
  Out of 1, 050 patients who received allo-BMTs between 1998 and 2000 in 21 Korean hospitals, 752 with first allo-BMT and complete data were included in this study. Study subjects were divided into the following three groups according to cumulative hospital experience of all-BMTs during the study period: low (< 30 cases), medium (30-49) and high (> or =50 cases) volume. Patient outcome was defined as early survival at day 100 and one-year survival. Multiple logistic regression analyses were performed to examine the association between hospital experience and survival at day 100 and one year.
  
  
  RESULTS
  When the low volume group was defined as the reference group, the adjusted relative risks (RR) of survival at day 100 for the high volume group were 2.46 (95% CI, 1.13-5.36) for all patients, 2.61 (1.04-6.57) for those with leukemia, and 2.20 (0.47-10.32) for those with aplastic anemia. For one-year survival, adjusted RR for the high volume group were 2.52 (1.40-4.51) for all patients, 1.99 (1.01-3.93) for leukemia, and 6.50 (1.57-26.80) for aplastic anemia. None of the RR for the medium volume group was statistically significant. Patient factors showing significant relationship with survival were donor-recipient relation, human leukocyte antigen matching status, time from diagnosis to transplant, and disease stage.
  
  
  CONCLUSIONS
  The study results suggest that the cumulative experience of hospitals in providing allo-BMT is positively associated with patient survival.
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Korea.
authors.forename: Choon Seon
authors.initials: CS
authors.lastname: Park
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Korea.
authors.forename: Hee Kyung
authors.initials: HK
authors.lastname: Moon
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Korea.
authors.forename: Hye Young
authors.initials: HY
authors.lastname: Kang
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Korea.
authors.forename: Yoo Hong
authors.initials: YH
authors.lastname: Min
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Korea.
authors.forename: Woo Hyun
authors.initials: WH
authors.lastname: Cho
keywords: Allogeneic bone marrow transplantation; Hospital procedure volume; Post-transplant survival; Volume-outcome relationship