Association of Hospital Procedure Volume with Post-Transplant Survival for Allogeneic Bone Marrow Transplantation.

Park, Choon Seon; Moon, Hee Kyung; Kang, Hye Young; Min, Yoo Hong; Cho, Woo Hyun

Original Article

Korean Journal of Preventive Medicine 2004;37(1): 26-36.

Choon Seon Park, Hee Kyung Moon, Hye Young Kang, Yoo Hong Min, Woo Hyun Cho

¹Department of Public Health, Graduate School, Yonsei University, Korea.
²Health Insurance Review Agency, Korea.
³Graduate School of Public Health, Yonsei University, Korea.
⁴Department of Internal Medicine, College of Medicine, Yonsei University, Korea.
⁵Department of Preventive Medicine and Public Health, College of Medicine, Yonsei University, Korea. whcho@yumc.yonsei.ac.kr

ABSTRACT

OBJECTIVE: To examine the association between hospital procedure volume and treatment outcomes following allogeneic bone marrow transplantation (allo-BMT). METHODS: Out of 1, 050 patients who received allo-BMTs between 1998 and 2000 in 21 Korean hospitals, 752 with first allo-BMT and complete data were included in this study. Study subjects were divided into the following three groups according to cumulative hospital experience of all-BMTs during the study period: low (< 30 cases), medium (30-49) and high (> or =50 cases) volume. Patient outcome was defined as early survival at day 100 and one-year survival. Multiple logistic regression analyses were performed to examine the association between hospital experience and survival at day 100 and one year. RESULTS: When the low volume group was defined as the reference group, the adjusted relative risks (RR) of survival at day 100 for the high volume group were 2.46 (95% CI, 1.13-5.36) for all patients, 2.61 (1.04-6.57) for those with leukemia, and 2.20 (0.47-10.32) for those with aplastic anemia. For one-year survival, adjusted RR for the high volume group were 2.52 (1.40-4.51) for all patients, 1.99 (1.01-3.93) for leukemia, and 6.50 (1.57-26.80) for aplastic anemia. None of the RR for the medium volume group was statistically significant. Patient factors showing significant relationship with survival were donor-recipient relation, human leukocyte antigen matching status, time from diagnosis to transplant, and disease stage. CONCLUSION: The study results suggest that the cumulative experience of hospitals in providing allo-BMT is positively associated with patient survival.

Key words: Volume-outcome relationship; Allogeneic bone marrow transplantation; Hospital procedure volume; Post-transplant survival