Centre volume and liver transplantation

Every issue of HPB, the three associate editors of the journal, Mark Callery, Saxon Connor and myself, are tasked to write a very short commentary or highlight about one of the papers published in that issue. Sometimes James Garden contributes too. This is my highlight for the current month August.

Centre volume and Liver Transplantation.
Whether you like it or not, health economics are a driving force in modern healthcare design. Rationalizing treatments, particularly those that are very expensive, needs to be based both on cost and outcomes. In the study by Macomber et al. in this month’s HPB, liver transplantation outcomes and costs were investigated in relation to centre case volume in 63 US health care centres.

What they found was that high volume centres, defined as those perfoming more than 75 liver transplants per year had lower morbidity and mortality rates than lower volume centres and were also more cost efficient. In some health care systems geography demands
the establishment of small volume centres but in those where such issues are not so pressing it may become difficult to justify having higher cost and worse performing small centres, in some cases in the same city, as a high performing lower cost centre. Thankfully such decisions usually lie in the hands of the regulators in public health care systems but in private health care systems patients may well vote with their feet if the data
are made public.

The volume debate continues and has touched just about every surgical discipline. Liver transplantation is often looked on as a ‘prestige programme’ and health care providers are reluctant to give up such practice. It will be interesting to see if this study has any influence on the size and organization of centres in the USA.

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