| Autor: |
Schrem, Harald, Volz, Sophia, Koch, Hans-Friedrich, Gwiasda, Jill, Kürsch, Priscila, Goldis, Alon, Pöhnert, Daniel, Winny, Markus, Klempnauer, Jürgen, Kaltenborn, Alexander |
| Předmět: |
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| Zdroj: |
Langenbeck's Archives of Surgery; Feb2018, Vol. 403 Issue 1, p61-71, 11p |
| Abstrakt: |
Purpose: This study investigated the utility of retrospective two one-sided cumulative sum (CUSUM) charts combined with multivariable regression analysis in liver transplantation for transplant center benchmarking.Methods: One thousand seven hundred and forty-nine consecutive adult primary liver transplants (January 1, 1983 to December 31, 2012) were analyzed retrospectively with two one-sided CUSUM chart analysis of 90-day mortality.Results: Three eras and two subseries in latest era 3 were identified due to graphically delineated relevant shifts in mean 90-day mortality. Delineation of eras 1, 2, and 3 coincided with relevant changes in allocation policies. CUSUM analysis detected a resurgence of higher mean 90-day mortality in era 3 after results had improved continuously over 25 years. In era 3, two subseries were identified with improving mean 90-day mortality rates from 15.4% in subseries 1 to 8.9% in the following subseries 2. The quantitative influence of independent risk factors on 90-day mortality differed markedly between all identified eras and subseries as assessed with multivariable regression analysis deployed on era-specific subcohorts.Conclusion: The assessed methodology is able to identify meaningful center-specific eras and subseries of liver transplantation with striking alterations of the significance and weight of outcome drivers for post-transplant 90-day mortality over time. This warrants the introduction of prospective risk-adjusted two one-sided CUSUM chart analysis into quality management in liver transplantation in Germany with the goal to obtain alarm signals as early as possible. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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