V. K. Dhar1, Y. Kim1, K. Wima1, B. T. Xia1, R. Hoehn1, T. Diwan1, S. A. Shah1 1University Of Cincinnati,Department Of Surgery,Cincinnati, OH, USA
Introduction: While increased hospital volume has been correlated with improved outcomes in certain surgical procedures, the effect of center volume on pancreas transplantation (PT) is less understood. Our study aims to establish whether a volume-outcome effect exists for pancreas transplantation.
Methods: Through an established linkage between the University HealthSystem Consortium and the Scientific Registry of Transplant Recipients databases, we performed a retrospective cohort analysis of adult PT recipients between 2009 and 2012. Surgical volume was trichotomized equally into low volume (LV), middle volume (MV), and high volume (HV) tertiles for each year that was studied. Median follow-up period was two years. Statistical analysis was performed using regression analyses and the Kaplan-Meier method.
Results: Among the 2,309 PT recipients included, 815 (35.3%) were performed at LV centers, 755 (32.7%) at MV centers, and 739 (32.0%) at HV centers. Compared with PT recipients at MV and LV centers, HV patients were more likely to have private insurance (51.7% vs 46.1% vs 39.9%, P < 0.0001), be of older age (31.5% >50 years old vs. 20.9% vs. 19.8%, P < 0.0001) and have worse functional status (38.3% dependent vs. 9.4% vs. 9.5%, P < 0.0001). Patient and graft survival were similar across hospital volume tertiles. Center volume was not predictive of readmission rates, total length of stay, intensive care unit length of stay, or total direct cost on multivariate analysis.
Conclusion: Whereas low surgical volume portends worse outcomes in selected procedures, short and long term PT outcomes are not affected by hospital volume. However, HV centers treat patients who are older and have worse functional status, without adversely impacting their short term performance.