More heart transplants done, better outcomes

A new study says centers that perform 14 or more transplants a year have lower mortality rates.

By Kevin B. O'Reilly, AMNews staff. March 3, 2008.

Hospitals that do fewer than 14 heart transplants a year see significantly more patients die within 30 days than do higher-volume transplant centers, according to a study of United Network for Organ Sharing data.

Researchers argued that physicians and policymakers should steer patients toward high-volume transplant centers to get better outcomes.

But other experts said transplant volume is not the only factor that should be considered when aiming for quality.

"This is not a new concept," said study co-investigator John V. Conte, MD, director of heart and lung transplantation at Johns Hopkins Hospital in Baltimore, which handles 20 to 30 heart transplants annually. "The evidence shows that the more you do of any complex procedure, the better that people are going to be at it."

Previous studies documented a relationship between surgical volume and outcomes.

Dr. Conte and his colleagues at Johns Hopkins' cardiac surgery division evaluated 30-day mortality rates for more than 14,000 heart recipients at 143 transplant centers from 1999 to 2006. They presented their findings at the Society of Thoracic Surgeons annual meeting in late January.

Centers that did more than 10 heart transplants a year averaged a 5.6% one-month mortality rate. That rate was 52% lower than centers that did fewer than 10, 64% lower than those that handled less than five cases and nearly two times lower than centers that averaged two cases or less.

Meanwhile, patients who received new hearts at centers that conducted fewer than 10 heart transplants had a 30-day mortality rate 80% higher than the national average. Those who got hearts at one of the eight centers that does more than 40 heart transplants a year were half as likely to die within 30 days, compared with the national average.