Wide variation in patient survival among US lung transplantation centers
MedWire News: There are significant variations in patient survival rates among lung transplantation centers in the USA, researchers have found.
"The observation that this variability among centers remains after controlling for differences in the selection of donors, recipients, or surgical approaches suggests that centers may exhibit true differences in the quality of care provided during or following transplantation," comments the team.
Gabriel Thabut (Mayo Clinic College of Medicine, Rochester, Minnesota, USA) and colleagues analyzed data on survival rates among 15,642 adults who underwent lung transplantation in 61 US transplantation centers between 1987 and 2009. Their findings appear in the Journal of the American Medical Association.
Overall survival rates among patients were 93.4% at 1 month, 79.7% at 1 year, 63.0% at 3 years, and 49.5% at 5 years. Median survival was 4.9 years.
There were significant between-center differences in the characteristics of donors and recipients, as well as in the type of surgical techniques used to perform lung transplantation.
After accounting for these differences, however, the team found significant and wide variations in patient survival rates among the centers, with adjusted mean 5-year survival rates ranging from 30.0% at some centers to 61.1% at others.
Patients treated at centers that performed a high number of lung transplantation operations tended to have better long-term survival than those treated at centers that performed a low number of lung transplants. But surgical volume only accounted for 15.0% of between-center variability in survival rates, the researchers note.
Thabut and team conclude: "This study of all lung transplantations performed in the USA reveals clinically and statistically significant variability among centers in survival after transplantation. Thus, the center where a patient undergoes lung transplantation may be a major determinant of survival rate."
They add: "There is a great need to explore practices at high-performing centers with the goal of exporting beneficial practices to lower-performing centers. If such efforts do not equalize outcomes for lung transplant recipients, consideration might be given to further regionalizing the lung transplantation system in the USA."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Mark Cowen