title: Procedural volume and survival after lung transplantation in the United States: the need to look beyond volume in the establishment of quality metrics.
abstract: BACKGROUND
  We sought to evaluate the effect of center volume on patient survival.
  
  
  METHODS
  We performed a retrospective analysis on nationwide data from the Scientific Registry of Transplant Recipients provided by United Network for Organ Sharing pertaining to lung transplantation (LT) recipients transplanted between 2005 and 2013. Centers were categorized into 4 groups based on their annual volume as follows: less than 20, 20 to 29, 30 to 39, and greater than or equal to 40 LTs. Baseline characteristics were compared and Kaplan-Meier analysis was used to estimate survival.
  
  
  RESULTS
  A total of 13,506 adult recipients underwent LT during the study period. Of these, 2,491 (18.4%) patients were transplanted in centers with volume less than 20, 2,562 (19.0%) in centers with volume 20 to 29, 2,998 (22.2%) in centers with volume 30 to 39, and 5,455(40.4%) in centers with volume greater than or equal to 40. Survival was poorest in the lowest volume centers (1-year 81.4% vs 85.5% and 5-year 49.7% vs 56.5%, respectively).
  
  
  CONCLUSIONS
  Post-LT survival in low volume centers is significantly lower than in high volume centers but the explanatory power of volume as a predictor of survival is low.
authors.affiliation: Department of Cardiothoracic Surgery, DeVos Heart & Lung Transplantation Program, Spectrum Health-Michigan State University, 330 Barclay Avenue NE, Suite 200, Grand Rapids, MI 49503, USA. Electronic address: jhayanga@me.com.
authors.forename: Jeremiah A
authors.initials: JA
authors.lastname: Hayanga
authors.affiliation: Department of Pulmonary-Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Alena
authors.initials: A
authors.lastname: Lira
authors.affiliation: Department of Cardiothoracic Surgery, DeVos Heart & Lung Transplantation Program, Spectrum Health-Michigan State University, 330 Barclay Avenue NE, Suite 200, Grand Rapids, MI 49503, USA.
authors.forename: Tedi
authors.initials: T
authors.lastname: Vlahu
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: D'Cunha
authors.affiliation: Department of Anesthesia, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Heather K
authors.initials: HK
authors.lastname: Hayanga
authors.affiliation: Department of Cardiothoracic Surgery, DeVos Heart & Lung Transplantation Program, Spectrum Health-Michigan State University, 330 Barclay Avenue NE, Suite 200, Grand Rapids, MI 49503, USA.
authors.forename: Reda
authors.initials: R
authors.lastname: Girgis
authors.affiliation: Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Aboagye
authors.affiliation: Department of Cardiothoracic Surgery, DeVos Heart & Lung Transplantation Program, Spectrum Health-Michigan State University, 330 Barclay Avenue NE, Suite 200, Grand Rapids, MI 49503, USA.
authors.forename: Asghar
authors.initials: A
authors.lastname: Khaghani
mesh_terms: D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000401:mortality* / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends*; D014481:United States / Q000453:epidemiology; D016526:Workload
keywords: Lung transplantation; Survival; Volume