Journal of Gastrointestinal Surgery

, Volume 12, Issue 9, pp 1527–1533

Relationship Between Provider Volume and Outcomes For Orthotopic Liver Transplantation

Authors

    • Department of Surgery, Division of General SurgeryDuke University Medical Center
  • Ricardo Pietrobon
    • Department of Surgery, Division of Orthopaedic SurgeryDuke University Medical Center
    • Center for Excellence in Surgical OutcomesDuke University Medical Center
  • Janet E. Tuttle-Newhall
    • Department of Surgery, Division of General SurgeryDuke University Medical Center
  • Carlos E. Marroquin
    • Department of Surgery, Division of General SurgeryDuke University Medical Center
  • Bradley H. Collins
    • Department of Surgery, Division of General SurgeryDuke University Medical Center
  • Dev M. Desai
    • Department of Surgery, Division of General SurgeryDuke University Medical Center
  • Paul C. Kuo
    • Department of Surgery, Division of General SurgeryDuke University Medical Center
  • Theodore N. Pappas
    • Department of Surgery, Division of General SurgeryDuke University Medical Center
original article

DOI: 10.1007/s11605-008-0589-5

Cite this article as:
Scarborough, J.E., Pietrobon, R., Tuttle-Newhall, J.E. et al. J Gastrointest Surg (2008) 12: 1527. doi:10.1007/s11605-008-0589-5

Abstract

Introduction

Recent data suggests that the previously demonstrable relationship between hospital volume and outcomes for liver transplant procedures may no longer exist. Furthermore, to our knowledge, no study has been published examining whether individual surgeon volume is associated with outcomes in liver transplantation.

Materials and methods

The Nationwide Inpatient Sample database was used to obtain early clinical outcome and resource utilization data for liver transplant procedures performed in the USA from 1988 through 2003. The relationship between surgeon and hospital volume and early clinical outcomes was analyzed with and without adjustment for certain confounding variables such as patient age and presence of co-morbid disease.

Results

The in-hospital mortality rate, major postoperative complication rate, and length of hospital stay after liver transplantation did not differ significantly based on hospital procedural volume. These outcome variables did, however, exhibit a statistically significant inverse relationship with individual surgeon volume of liver transplant procedures. A significant relationship between procedure volume and outcomes for liver transplantation cannot be demonstrated at the level of transplant center, but does appear to exist at the level of the individual transplant center.

Conclusion

Minimal volume requirements for individual liver transplant surgeons may be justified, pending validation of this volume–outcomes relationship using a clinical data source.

Keywords

Liver transplantation Outcomes assessment Resource utilization Provider volume

Copyright information

© The Society for Surgery of the Alimentary Tract 2008