Thursday, January 01, 2009

Which Hospital Should One Go For Heart Transplant?

When patients suffer serious heart disease that causes their hearts to fail, the only thing the doctor can do for them is to perform a heart transplant if everything else are tried for.

No doubt, heart transplant is a sophisticated surgery, yet it is not uncommon nowadays as many hospitals are doing such procedures. However, is there a way that the patients can evaluate which hospital is best for the procedure, in view of the high risk and cost involved? The key is to check the surgical volumes to see which hospitals teams operating at their peak skill level.

According to the prevailing guideline set by US Centers for Medicare and Medicaid Services, which qualifies hospitals for federal reimbursement, a hospital can be considered as a high-volume center if at least 10 procedures were performed every year. The previous figure was 12.

However, a new study, presented on January 30, 2008 at the Society of Thoracic Surgeons meeting in Fort Lauderdale, Florida, argued that the number of procedures should be at least 14 instead. The researchers from Johns Hopkins University, Baltimore, Maryland studied 14,401 subjects who underwent heart transplant in the United States between 1999 and 2006.

Their findings indicated that patients’ mortality at 30 days and at 1 year after heart transplant increased as the annual procedure volume decreased. For example, a center that performs more than 40 heart transplants per year has less than 1 percent for the patient’s mortality rate 30 days after surgery. On the other hand, centers having less than 10 procedures performed, the 30-day mortality rate is increased by 80 percent.

However, once 14 cases per annum were reached, each additional procedure would have very little impact on the risk of death. Therefore, 14 were taken as threshold.

The researchers also revealed that the majority of the 143 United States medical centers that are licensed to perform heart transplant in fact do fewer than 14 cases per year. According to their figures, less than 5 centers do more than 40 and less than 10 do more than 30 procedures. They also blamed many low-volume hospitals just simply refuse to stop their program despite of very poor result.

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