Harald Schrem1,2, Sophia Volz1, Hans-Friedrich Koch1, Jill Gwiasda1, Priscila Kürsch1, Alon Goldis1, Daniel Pöhnert2, Markus Winny2, Jürgen Klempnauer2, Alexander Kaltenborn3,4. 1. Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany. 2. Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany. 3. Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany. kaltenborn.alexander@mh-hannover.de. 4. Department of Trauma and Orthopedic Surgery, Federal Armed Forces Hospital, Westerstede, Germany. kaltenborn.alexander@mh-hannover.de.
Abstract
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.
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.
Authors: Tobias J Weismüller; Ahmed Negm; Thomas Becker; Hannelore Barg-Hock; Jürgen Klempnauer; Michael P Manns; Christian P Strassburg Journal: Transpl Int Date: 2009-07-10 Impact factor: 3.782
Authors: Harald Schrem; Moritz Focken; Bridget Gunson; Benedikt Reichert; Darius Mirza; Hans-Heinrich Kreipe; Desley Neil; Alexander Kaltenborn; Alon Goldis; Christian Krauth; Keith Roberts; Thomas Becker; Jürgen Klempnauer; James Neuberger Journal: Liver Transpl Date: 2016-06 Impact factor: 5.799
Authors: Tobias J Weismüller; Panagiotis Fikatas; Jan Schmidt; Ana P Barreiros; Gerd Otto; Susanne Beckebaum; Andreas Paul; Markus N Scherer; Hartmut H Schmidt; Hans J Schlitt; Peter Neuhaus; Jürgen Klempnauer; Johann Pratschke; Michael P Manns; Christian P Strassburg Journal: Transpl Int Date: 2010-09-03 Impact factor: 3.782
Authors: Henrik Petrowsky; Abbas Rana; Fady M Kaldas; Anuj Sharma; Johnny C Hong; Vatche G Agopian; Francisco Durazo; Henry Honda; Jeffrey Gornbein; Victor Wu; Douglas G Farmer; Jonathan R Hiatt; Ronald W Busuttil Journal: Ann Surg Date: 2014-06 Impact factor: 12.969
Authors: Soufiane Filali Bouami; Jill Gwiasda; Jan Beneke; Alexander Kaltenborn; Sebastian Liersch; Eduardo M Suero; Hans-Friedrich Koch; Christian Krauth; Jürgen Klempnauer; Harald Schrem Journal: Langenbecks Arch Surg Date: 2018-04-02 Impact factor: 3.445