Effect of Case Volume on Mortality After Pediatric Liver Transplantation in Korea

Hannah Lee, Eun Jin Jang, Ga Hee Kim, Nam Joon Yi, Dal Ho Kim, Seokha Yoo, Hyung Sang Row, Chul Woo Jung, Seung Young Oh, Ho Geol Ryu

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The purpose of this study was to evaluate whether institutional case-volume affects clinical outcomes after pediatric liver transplantation. METHODS: We conducted a nationwide retrospective cohort study using the database of Korean National Healthcare Insurance Service. Between January 2007 and December 2016, 521 pediatric liver transplantations were performed at 22 centers in Korea. Centers were categorized according to the average annual number of liver transplantations: >10, 1 to 10, and <1. RESULTS: In-hospital mortality rates in the high-, medium-, and low-volume centers were 5.8%, 12.5%, and 32.1%, respectively. After adjustment, in-hospital mortality was significantly higher in low-volume centers (adjusted odds ratio, 9.693; 95% confidence interval, 4.636-20.268; P < 0.001) and medium-volume centers (adjusted odds ratio, 3.393; 95% confidence interval, 1.980-5.813; P < 0.001) compared to high-volume centers. Long-term survival for up to 9 years was better in high-volume centers. CONCLUSIONS: Centers with higher case volume (>10 pediatric liver transplantations/y) had better outcomes after pediatric liver transplantation, including in-hospital mortality and long-term mortality, compared to centers with lower case volume (≤10 liver transplantations/y).

Original languageEnglish
Pages (from-to)1649-1654
Number of pages6
JournalTransplantation
Volume103
Issue number8
DOIs
StatePublished - 1 Aug 2019

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Korea
Liver Transplantation
Pediatrics
Mortality
Hospital Mortality
Insurance
Cohort Studies
Retrospective Studies
Databases
Delivery of Health Care

Cite this

@article{9d2efaf435b44771aafb3eb50f3d99dc,
title = "Effect of Case Volume on Mortality After Pediatric Liver Transplantation in Korea",
abstract = "BACKGROUND: The purpose of this study was to evaluate whether institutional case-volume affects clinical outcomes after pediatric liver transplantation. METHODS: We conducted a nationwide retrospective cohort study using the database of Korean National Healthcare Insurance Service. Between January 2007 and December 2016, 521 pediatric liver transplantations were performed at 22 centers in Korea. Centers were categorized according to the average annual number of liver transplantations: >10, 1 to 10, and <1. RESULTS: In-hospital mortality rates in the high-, medium-, and low-volume centers were 5.8{\%}, 12.5{\%}, and 32.1{\%}, respectively. After adjustment, in-hospital mortality was significantly higher in low-volume centers (adjusted odds ratio, 9.693; 95{\%} confidence interval, 4.636-20.268; P < 0.001) and medium-volume centers (adjusted odds ratio, 3.393; 95{\%} confidence interval, 1.980-5.813; P < 0.001) compared to high-volume centers. Long-term survival for up to 9 years was better in high-volume centers. CONCLUSIONS: Centers with higher case volume (>10 pediatric liver transplantations/y) had better outcomes after pediatric liver transplantation, including in-hospital mortality and long-term mortality, compared to centers with lower case volume (≤10 liver transplantations/y).",
author = "Hannah Lee and Jang, {Eun Jin} and Kim, {Ga Hee} and Yi, {Nam Joon} and Kim, {Dal Ho} and Seokha Yoo and Row, {Hyung Sang} and Jung, {Chul Woo} and Oh, {Seung Young} and Ryu, {Ho Geol}",
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pages = "1649--1654",
journal = "Transplantation",
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Effect of Case Volume on Mortality After Pediatric Liver Transplantation in Korea. / Lee, Hannah; Jang, Eun Jin; Kim, Ga Hee; Yi, Nam Joon; Kim, Dal Ho; Yoo, Seokha; Row, Hyung Sang; Jung, Chul Woo; Oh, Seung Young; Ryu, Ho Geol.

In: Transplantation, Vol. 103, No. 8, 01.08.2019, p. 1649-1654.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of Case Volume on Mortality After Pediatric Liver Transplantation in Korea

AU - Lee, Hannah

AU - Jang, Eun Jin

AU - Kim, Ga Hee

AU - Yi, Nam Joon

AU - Kim, Dal Ho

AU - Yoo, Seokha

AU - Row, Hyung Sang

AU - Jung, Chul Woo

AU - Oh, Seung Young

AU - Ryu, Ho Geol

PY - 2019/8/1

Y1 - 2019/8/1

N2 - BACKGROUND: The purpose of this study was to evaluate whether institutional case-volume affects clinical outcomes after pediatric liver transplantation. METHODS: We conducted a nationwide retrospective cohort study using the database of Korean National Healthcare Insurance Service. Between January 2007 and December 2016, 521 pediatric liver transplantations were performed at 22 centers in Korea. Centers were categorized according to the average annual number of liver transplantations: >10, 1 to 10, and <1. RESULTS: In-hospital mortality rates in the high-, medium-, and low-volume centers were 5.8%, 12.5%, and 32.1%, respectively. After adjustment, in-hospital mortality was significantly higher in low-volume centers (adjusted odds ratio, 9.693; 95% confidence interval, 4.636-20.268; P < 0.001) and medium-volume centers (adjusted odds ratio, 3.393; 95% confidence interval, 1.980-5.813; P < 0.001) compared to high-volume centers. Long-term survival for up to 9 years was better in high-volume centers. CONCLUSIONS: Centers with higher case volume (>10 pediatric liver transplantations/y) had better outcomes after pediatric liver transplantation, including in-hospital mortality and long-term mortality, compared to centers with lower case volume (≤10 liver transplantations/y).

AB - BACKGROUND: The purpose of this study was to evaluate whether institutional case-volume affects clinical outcomes after pediatric liver transplantation. METHODS: We conducted a nationwide retrospective cohort study using the database of Korean National Healthcare Insurance Service. Between January 2007 and December 2016, 521 pediatric liver transplantations were performed at 22 centers in Korea. Centers were categorized according to the average annual number of liver transplantations: >10, 1 to 10, and <1. RESULTS: In-hospital mortality rates in the high-, medium-, and low-volume centers were 5.8%, 12.5%, and 32.1%, respectively. After adjustment, in-hospital mortality was significantly higher in low-volume centers (adjusted odds ratio, 9.693; 95% confidence interval, 4.636-20.268; P < 0.001) and medium-volume centers (adjusted odds ratio, 3.393; 95% confidence interval, 1.980-5.813; P < 0.001) compared to high-volume centers. Long-term survival for up to 9 years was better in high-volume centers. CONCLUSIONS: Centers with higher case volume (>10 pediatric liver transplantations/y) had better outcomes after pediatric liver transplantation, including in-hospital mortality and long-term mortality, compared to centers with lower case volume (≤10 liver transplantations/y).

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