While the federal government lowers the bar to certify hospitals for heart transplant work, Johns Hopkins doctors say more is better when it comes to experience.
The U.S. Centers for Medicare and Medicaid Services, which qualifies hospitals for federal reimbursement, recently lowered the standard on heart transplant surgeries from 12 to 10 per year for each hospital.
Heart surgeons at Johns Hopkins, however, say if hospitals can?t do 14 or more of these complicated open-chest surgeries in a year, they?re better off not doing the surgeries.
In a study presented at the 44th annual meeting of the Society of Thoracic Surgeons in Fort Lauderdale, the Hopkins team recommended the benchmark for designation as a high-volume hospital rise to 14 heart transplants per year. High-volume centers consistently show higher survival and fewer complication rates, the researchers reported.
“In the United States, too many low-volume hospitals have a program that they won?t let go of, no matter how poor the results,” said study co-investigator Dr. Stuart Russell, an associate professor at Hopkins.
Russell and cardiac surgeon Dr. John Conte reviewed the patient records of 14,401 men and women who received heart transplants in the United States between 1999 and 2006.
“Our results clearly demonstrate that current standards have been arbitrarily set too low,” says Conte, director of heart and lung transplantation at Hopkins. “There is a certain threshold, a minimum number of surgeries needed to maintain the expertise of the entire transplant team.”
More than 2,000 people undergo heart transplants each year in the United States, according to the United Network for Organ Sharing. Nearly 3,000 remain on waiting lists, and up to 20 percent of those will die while waiting. Costs for a heart transplant often run as high as $260,000.
