The Association Between Institutional Case Volume of Hematopoietic Stem Cell Transplantation and Mortality.

Background: Hematopoietic stem cell transplantation (HSCT) is a complex, high-risk procedure with significant morbidity and mortality. The positive impact of higher institutional case volume on survival has been reported in various high-risk procedures. The association between annual institutional HSCT case volume and mortality was analyzed using the National Health Insurance Service database.

Methods: Data on 16,213 HSCTs performed in 46 Korean centers between 2007 and 2018 were extracted. Centers were divided into low- or high-volume centers using an average of 25 annual cases as the cut-off. Adjusted odds ratios (OR) for 1-year mortality after allogeneic and autologous HSCT were estimated using multivariable logistic regression.

Results: For allogeneic HSCT, low-volume centers (≤25 cases/y) were associated with higher 1-year mortality (adjusted OR 1.17, 95% CI 1.04-1.31, P = .008). However, low-volume centers did not show higher 1-year mortality (adjusted OR 1.03, 95% CI 0.89-1.19, P = .709) for autologous HSCT. Long-term mortality after HSCT was significantly worse in low-volume centers (adjusted hazard ratio [HR] 1.17, 95% CI, 1.09-1.25, P < .001 and adjusted HR 1.09, 95% CI, 1.01-1.17, P = .024, allogeneic and autologous HSCT, respectively) compared with high-volume centers.

Conclusion: Our data suggest that higher institutional HSCT case volume seems to be associated with better short- and long-term survival.