TABLE 1.
Center-Level Differences by Rate of Potential Overtreatment
| All Centers 108 Centers (N = 19,539) | Bottom Quartile <3.4% Overtreatment 27 Centers (n = 3,658) | Top Quartile ≥14.6% Overtreatment 28 Centers (n = 5,020) | p Value | |
|---|---|---|---|---|
| Candidates at risk | 12,762 (65) | 2,345 (64) | 3,203 (64) | 0.951 |
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| OPO-level variables | ||||
| OPO listing volume | 101 ± 63 | 91 ± 68 | 149 ± 72 | 0.033 |
| OPO transplant volume | 63 ± 43 | 55 ± 42 | 97 ± 53 | 0.029 |
| OPO Status 1A transplant proportion | 0.62 ± 0.18 | 0.58 ± 0.20 | 0.71 ± 0.13 | 0.009 |
| OPO Status 1B transplant proportion | 0.34 ± 0.16 | 0.36 ± 0.18 | 0.23 ± 0.12 | 0.004 |
| OPO donor heart supply | 53 ± 29 | 40 ± 23 | 71 ± 35 | 0.004 |
| OPO HHI | 0.58 ± 0.26 | 0.63 ± 0.29 | 0.45 ± 0.20 | 0.041 |
| Number of centers in OPO | 2.7 ± 1.3 | 2.4 ± 1.3 | 3.5 ± 1.2 | 0.014 |
|
| ||||
| Center-level variables | ||||
| Center listing volume | 47 ± 30 | 42 ± 30 | 52 ± 41 | 0.551 |
| Center transplant volume | 29 ± 23 | 24 ± 17 | 36 ± 33 | 0.313 |
| Market share of center | 0.57 ± 0.31 | 0.58 ± 0.34 | 0.40 ± 0.27 | 0.054 |
| Proportion of center transplantations using OPO hearts | 0.63 ± 0.20 | 0.60 ± 0.23 | 0.59 ± 0.18 | 0.792 |
| Time to transplantation | 189 ±249 | 246 ± 273 | 144 ± 214 | <0.001 |
| 90-day transplantation rate | 0.31 ± 0.17 | 0.21 ± 0.13 | 0.40 ± 0.18 | <0.001 |
| 365-day transplantation rate | 0.55 ± 0.18 | 0.47 ± 0.17 | 0.62 ± 0.16 | <0.001 |
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| Listing status | <0.001 | |||
| Status 1A | 4,777 (24) | 537 (15) | 1,970 (39) | |
| Status 1B | 8,110 (42) | 1,815 (50) | 1,629 (32) | |
| Status 2 | 5,922 (30) | 1,184 (32) | 1,320 (26) | |
| Inactive | 730 (4) | 122 (3) | 101 (2) | |
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| Listing therapy | <0.001 | |||
| None | 6,252 (32) | 1,227 (34) | 1,386 (28) | |
| High-dose inotropes | 1,770 (9) | 78 (2) | 999 (20) | |
| IABP | 647 (3) | 60 (2) | 239 (5) | |
| ECMO | 212 (1) | 28 (1) | 60 (1) | |
| CF-LVAD | 4,599 (24) | 1,034 (28) | 1,134 (23) | |
| Low-dose single IV inotropes | 4,936 (25) | 1,028 (28) | 915 (18) | |
| Other | 647 (3) | 119 (3) | 211 (4) | |
Values are n (%) or mean±SD. All values calculated by year, excluding candidates with missing data or at low volume centers (n = 380). The p values for comparisons for between centers in the bottom and top quartile of overtreatment were calculated using generalized linear models with robust SE clustered by center.
CF-LVAD = continuous flow left ventricular assist device; ECMO = extracorporeal membrane oxygenation; HHI = Herfindahl-Hirschman index; IABP = intra-aortic balloon pump; IV = intravenous; OPO = organ procurement organization.