Definition and Analysis of Textbook Outcome: A Novel Quality Measure in Kidney Transplantation.
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2021-05
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Abstract
Background
"Textbook outcome" (TO) is a novel composite quality measure that encompasses multiple postoperative endpoints, representing the ideal "textbook" hospitalization for complex surgical procedures. We defined TO for kidney transplantation using a cohort from a high-volume institution.Methods
Adult patients who underwent isolated kidney transplantation at our institution between 2016 and 2019 were included. TO was defined by clinician consensus at our institution to include freedom from intraoperative complication, postoperative reintervention, 30-day intensive care unit or hospital readmission, length of stay > 75th percentile of kidney transplant patients, 90-day mortality, 30-day acute rejection, delayed graft function, and discharge with a Foley catheter. Recipient, operative, financial characteristics, and post-transplant patient, graft, and rejection-free survival were compared between patients who achieved and failed to achieve TO.Results
A total of 557 kidney transplant patients were included. Of those, 245 (44%) achieved TO. The most common reasons for TO failure were delayed graft function (N = 157, 50%) and hospital readmission within 30 days (N = 155, 50%); the least common was mortality within 90 days (N = 6, 2%). Patient, graft, and rejection-free survival were significantly improved among patients who achieved TO. On average, patients who achieved TO incurred approximately $50,000 less in total inpatient charges compared to those who failed TO.Conclusions
TO in kidney transplantation was associated with favorable post-transplant outcomes and significant cost-savings. TO may offer transplant centers a detailed performance breakdown to identify aspects of perioperative care in need of process improvement.Type
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Halpern, Samantha E, Dimitrios Moris, Brian I Shaw, Samuel J Kesseli, Mariya L Samoylova, Miriam Manook, Robin Schmitz, Bradley H Collins, et al. (2021). Definition and Analysis of Textbook Outcome: A Novel Quality Measure in Kidney Transplantation. World journal of surgery, 45(5). pp. 1504–1513. 10.1007/s00268-020-05943-y Retrieved from https://hdl.handle.net/10161/33507.
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Scholars@Duke
Samuel Kesseli
Bradley Henry Collins
(1) The laboratory's primary focus is the study of the feasibility of transplanting porcine islets into primates as a treatment for type 1 diabetes mellitus. There is a severe shortage of human cadaveric pancreas donors for the 1 to 2 million type 1 diabetics in the United States. The use of human islets would further exacerbate the problem as 2 or 3 pancreases are required per recipient. In collaboration with Dr. Emmanuel Opara, an islet cell physiologist, we have purified islets from porcine pancreases, placed the islets in microcapsules, and transplanted the islets into diabetic baboons without the use of immunosuppression. Our goal is to demonstrated the utility of this system as a pre-clinical model.
(2) Recently, my laboratory has developed an interest in senescence of the liver. The project is a collaborative effort with hepatologist Dr. Don Rockey. We induce cirrhosis in young and old mice with carbon tetrachloride and then extract the intrahepatic lymphocytes. FACS technology is used to identified the lymphocyte populations and then sort them. The cytokine profile is then elucidated. We plan to use gene chip technology to assess the gene expression.
Scott L Sanoff
Kadiyala Venkata Ravindra
Debra L Sudan
I am interested clinically in all abdominal organ transplants (kidney, liver, pancreas and intestine). I am specifically interested in intestine transplantation and improving intestine graft preservation and long-term graft function and patient survival. In addition, I am interested in monitoring of patients to improve our ability to determine the etiology of graft dysfunction when there are complex interacting issues such as infection and rejection as well as examining better immunosuppressive regimens to maintain excellent graft function. We have numerous research studies and trial to improve our knowledge in these areas and thereby contribute to improved patient outcomes!
Matthew Jay Ellis
Lisa M McElroy
I am an abdominal transplant surgeon with a health services research lab focused on understanding how complex health care processes and large multidisciplinary teams affect outcomes of high cost, high acuity patients. I have a master's degree in health services and outcomes research methodology with supplemental training in health disparities research methods, engineering methods for healthcare system and process assessment, organizational behavior theory and change management, and implementation science.
As my research has progressed, an emerging theme has been the interplay between biologic and social risk, which each contribute to a patient’s ultimate success but receive disproportionate consideration in anticipation of and in response to subpar outcomes. I am currently involved in several efforts that build on this concept and employ an approach to health equity research that accounts for center and organizational-level characteristics when examining differences in care based on social determinants of health.
Andrew Serghios Barbas
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