NEW YORK, US - PATIENTS who undergo heart transplant surgery in hospitals that perform 14 or more procedures each year achieve better outcomes than patients who undergo this procedure at hospitals that perform fewer heart transplants.

Recently, the US Centres for Medicare and Medicaid Services, which qualifies hospitals for federal reimbursement, reduced the number of heart transplants needed to be considered a high-volume centre from 12 to 10 per year. The current findings, however, indicate that the number should actually be increased to 14 procedures.

'Our national healthcare system has to rethink which hospitals should do heart transplants, and in consultation with their physicians, patients need to evaluate these surgical volumes to see for themselves which hospitals have teams operating at their peak skill level,' senior author Dr John Conte, from Johns Hopkins University, Baltimore, Maryland, said in a statement.

The findings indicate that patient mortality at 30 days and at 1 year after a heart transplant increased as the annual procedure volume decreased. For instance, a centre that performs more than 40 heart transplants per year has a patient mortality rate 30 days after surgery of less than 1 per cent.

In contrast, at centres with annual caseloads of less than 10, the 30-day mortality rate is increased by 80 per cent.

The results, however, show a threshold effect. Once 14 cases per year were reached, each additional case had little impact on the risk of death.

According to the researchers, the bulk of the 143 US medical centres licensed to perform heart transplantations do fewer than 14 cases per year. Fewer than 10 centres do more than 30 heart transplantations per year and less than 5 do more than 40.

'In the US, too many low-volume hospitals have a program that they won't let go of, no matter how poor the results,' study co-author Dr Stuart Russell, also from Johns Hopkins, said in a statement.-- REUTERS