BACKGROUND: Significant intercenter variation exists in mortality and death-censored graft loss (DCGL) after transplantation. Failure to rescue (FTR, death after a major complication) is an emerging tool in quality improvement and may underlie this variation. This study is the first effort to investigate the relationship between FTR and outcomes in transplantation to assess its utility in care improvement. METHODS: Using the Studies of Pediatric Liver Transplantation database, we identified 2330 children undergoing primary liver transplants at 21 centers. Centers were ranked by risk-adjusted mortality and sorted into tertiles. We then compared mortality, complications, and FTR across tertiles. RESULTS: Overall mortality was 4.9%, ranging from 1.4% to 8.1% in the low and high mortality tertiles (P < 0.01). The low mortality tertile had significantly lower rates of complications (30.9% vs 38.5% and 40.4%, P < 0.01) as well as FTR (4.6% vs 9.9% and 14.3%, P < 0.01). A similar trend was seen in the DCGL analysis. CONCLUSIONS: Our results demonstrate that although centers with higher mortality and DCGL have more frequent major complications, they exhibit 3-fold the rate of FTR. Efforts to standardize perioperative care, and thus minimize FTR, will have value to pediatric liver transplantation recipients. This preliminary study indicates that FTR may provide a useful quality improvement tool for the field of transplantation and warrants further investigation.
BACKGROUND: Significant intercenter variation exists in mortality and death-censored graft loss (DCGL) after transplantation. Failure to rescue (FTR, death after a major complication) is an emerging tool in quality improvement and may underlie this variation. This study is the first effort to investigate the relationship between FTR and outcomes in transplantation to assess its utility in care improvement. METHODS: Using the Studies of Pediatric Liver Transplantation database, we identified 2330 children undergoing primary liver transplants at 21 centers. Centers were ranked by risk-adjusted mortality and sorted into tertiles. We then compared mortality, complications, and FTR across tertiles. RESULTS: Overall mortality was 4.9%, ranging from 1.4% to 8.1% in the low and high mortality tertiles (P < 0.01). The low mortality tertile had significantly lower rates of complications (30.9% vs 38.5% and 40.4%, P < 0.01) as well as FTR (4.6% vs 9.9% and 14.3%, P < 0.01). A similar trend was seen in the DCGL analysis. CONCLUSIONS: Our results demonstrate that although centers with higher mortality and DCGL have more frequent major complications, they exhibit 3-fold the rate of FTR. Efforts to standardize perioperative care, and thus minimize FTR, will have value to pediatric liver transplantation recipients. This preliminary study indicates that FTR may provide a useful quality improvement tool for the field of transplantation and warrants further investigation.
Authors: James E Squires; Beth Logan; Angela Lorts; Henrisa Haskell; Kristen Sisaithong; Tony Pillari; Jonathan Szolna; Darcy Dodd; Regino P Gonzalez-Peralta; Evelyn Hsu; Beau Kelly; Beverly Kosmach-Park; Steven Lobritto; Vicky L Ng; Emily Perito; Sara Rasmussen; Rene Romero; Eyal Shemesh; Hannah Karolak; George V Mazariegos Journal: Pediatr Transplant Date: 2019-07-22
Authors: Lucy W Ma; Justin S Hatchimonji; Elinore J Kaufman; Catherine E Sharoky; Brian P Smith; Daniel N Holena Journal: Surgery Date: 2019-05-07 Impact factor: 3.982
Authors: Faisal S Dar; Abu Bakar H Bhatti; Ammal I Qureshi; Nusrat Y Khan; Zahaan Eswani; Haseeb H Zia; Eitzaz U Khan; Nasir A Khan; Atif Rana; Najmul H Shah; Mohammad Salih; Rashid Nazer Journal: World J Surg Date: 2018-04 Impact factor: 3.352
Authors: Justin S Hatchimonji; Elinore J Kaufman; Catherine E Sharoky; Lucy Ma; Anna E Garcia Whitlock; Daniel N Holena Journal: J Trauma Acute Care Surg Date: 2019-09 Impact factor: 3.313
Authors: Mounika Kanneganti; Yuwen Xu; Yuan-Shung Huang; Eimear Kitt; Brian T Fisher; Peter L Abt; Elizabeth B Rand; Douglas E Schaubel; Therese Bittermann Journal: Liver Transpl Date: 2021-08-25 Impact factor: 5.799
Authors: Sharad I Wadhwani; Chiung-Yu Huang; Laura Gottlieb; Andrew F Beck; John Bucuvalas; Uma Kotagal; Courtney Lyles; Jennifer C Lai Journal: Am J Transplant Date: 2021-03-04 Impact factor: 9.369