Effect of Transplant Center Volume on Cost and Readmissions in Medicare Lung Transplant Recipients

Rationale: Although lung transplant recipient survival is better at higher volume centers, the effect of center volume on admission cost and early hospital readmission is unknown.

Objectives: To understand the association between transplant center volume and recipient risk-adjusted transplant admission cost, in-hospital mortality, and early hospital readmission in lung transplant recipients.

Methods: Medicare lung transplant recipients from May 4, 2005 to December 31, 2011 were identified through linkage of transplant registry and Medicare administrative claims. Transplant admission cost was extracted, adjusted for regional price variation, and compared across low-, intermediate-, and high-volume centers. A multivariable hierarchical generalized linear regression model was used to assess the effect of transplant center volume on recipient adjusted cost. Modified Poisson regression models were used to assess adjusted in-hospital mortality and early hospital readmission by transplant center volume.

Measurements and Main Results: There were 3,128 Medicare lung transplant recipients identified. Unadjusted transplant cost was lower at high-volume centers (mean, $131,352 [SD, ±$106,165]; median, $90,177; interquartile range [IQR], $79,165–$137,915) than at intermediate-volume (mean, $138,792 [SD, ±$106,270]; median, $93,024; IQR, $82,700–$154,857) or low-volume (mean, $143,609 [SD, ±$123,316]; median, $95,234; IQR, $83,052–$152,149) centers (P < 0.0001). After adjusting for recipient health risk, low-volume centers had an 11.66% greater transplant admission cost (P = 0.040), a 41% greater risk for in-hospital mortality (P = 0.015), and a 14% greater risk for early hospital readmission (P = 0.033) compared with high-volume centers. There was no significant difference in transplant cost, in-hospital mortality, or early hospital readmission between intermediate- and high-volume centers.

Conclusions: Lung transplant admission cost, in-hospital mortality, and early hospital readmission rate are lower at high-volume centers compared with low-volume centers.