Textbook surgical outcome in lung transplantation: Analysis of a US national registry.

Autor: Krischak MK; School of Medicine, Duke University, Durham, North Carolina, USA., Au S; School of Medicine, Duke University, Durham, North Carolina, USA., Halpern SE; School of Medicine, Duke University, Durham, North Carolina, USA., Olaso DG; School of Medicine, Duke University, Durham, North Carolina, USA., Moris D; Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA., Snyder LD; Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA., Barbas AS; Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA., Haney JC; Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA., Klapper JA; Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA., Hartwig MG; Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2022 Apr; Vol. 36 (4), pp. e14588. Date of Electronic Publication: 2022 Jan 23.
DOI: 10.1111/ctr.14588
Abstrakt: Intro: Textbook surgical outcome (TO) is a novel composite quality measure in lung transplantation (LTx). Compared to 1-year survival metrics, TO may better differentiate center performance, and motivate improvements in care. To understand the feasibility of implementing this metric, we defined TO in LTx using US national data, and evaluated its ability to predict post-transplant outcomes and differentiate center performance.
Methods: Adult patients who underwent isolated LTx between 2016 and 2019 were included. TO was defined as freedom from post-transplant length of stay > 30 days, 90-day mortality, intubation or extracorporeal membrane oxygenation at 72 h post-transplant, post-transplant ventilator support lasting ≥5 days, postoperative airway dehiscence, inpatient dialysis, pre-discharge acute rejection, and grade 3 primary graft dysfunction at 72 h. Recipient and donor characteristics and post-transplant outcomes were compared between patients who achieved and failed TO.
Results: Of 8959 lung transplant recipients, 4664 (52.1%) achieved TO. Patient and graft survival were improved among patients who achieved TO (both log-rank P < .0001). Among 62 centers, adjusted rates of TO ranged from 27.0% to 72.4% reflecting a wide variability in center-level performance.
Conclusion: TO defined using national data may represent a novel composite metric to guide quality improvement in LTx across US transplant centers.
Summary: In this study we defined textbook outcome (TO) for lung transplantation (LTx) using US national data. We found that achievement of TO was associated with improved post-transplant survival, and wide variability in center-level LTx performance. These findings suggest that TO could be readily implemented to compare quality of care among US LTx centers.
(© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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