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KMID : 0371020040370010026
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Journal of Preventive Medicine and Public Health
2004 Volume.37 No. 1 p.26 ~ p.36
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Association of Hospital Procedure Volume with Post-Transplant Survival for Allogeneic Bone Marrow Transplantation.
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Park Choon-Seon
Moon Hee-Kyung
Kang Hye-Young
Min Yoo-Hong
Cho Woo-Hyun
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Abstract
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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 (≥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.
Conclusions: The study results suggest that the cumulative experience of hospitals in providing allo-BMT is positively associated with patient survival.
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KEYWORD
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Volume-outcome relationship, Allogeneic bone marrow transplantation, Hospital procedure volume, Post-transplant survival
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