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Correspondence

Reply

Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 1820 Bank St, Baltimore, MD 21231

(Email: eweiss3{at}jhmi.edu).

To the Editor:

We would like to thank Dr Schuch for his comments [1] on our study of the effect of hospital volume on outcomes in orthotopic heart transplantation (OHT) [2]. His point that the volume of open heart procedures may be an important factor influencing outcomes in OHT is certainly well taken. In our analysis, we were unable to include the number of open heart procedures (other than OHT) performed at the institutions we examined. These data are not included in the United Network for Organ Sharing (UNOS) data set, and for privacy reasons, there is appropriately no way to identify hospitals to allow for a more detailed analysis beyond what was performed.

The comments by Dr Schuch, however, highlight a broader issue involved in interpreting studies of outcomes relating to hospital or provider volume. Specifically, volume by itself is likely a surrogate for unknown processes of care affecting outcomes. Factors such as surgeon experience, dedicated intensive care unit providers, nursing experience, critical pathway implementation, and specialized ancillary staff, among many others, are emerging as potentially important predictors for short-term outcomes. Given the complexity of OHT, it is reasonable to believe that a multitude of factors are at play beyond any measure of volume, including open cardiac case volume. Volume outcome analyses are important for providing early insight, but more detailed multi-institutional data must be collected to examine this issue fully.

We agree that low-volume centers reporting good outcomes should be allowed to continue to perform OHT. At this time, however, we have no data to suggest that these centers are those with a high or low volume of open heart procedures. Again, on behalf of our coauthors, we would like Dr Schuch for addressing our article and discussing this issue.

	References

Top References

 

1. Schuch D. CMS standards in reviewing low-volume cardiac transplant centers (letter) Ann Thorac Surg 2009;87:1654.[Free Full Text]
2. Weiss ES, Meguid RA, Patel ND, et al. Increased mortality at low-volume orthotopic heart transplantation centers: should current standards change? Ann Thorac Surg 2008;86:1250-1260.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John V. Conte Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Weiss, E. S. Articles by Conte, J. V. Search for Related Content PubMed PubMed Citation Articles by Weiss, E. S. Articles by Conte, J. V. Related Collections Related Article