Textbook Outcome: Definition and Analysis of a Novel Quality Measure in Kidney Transplantation
1Duke University School of Medicine, Durham, NC, 2Department of Surgery, Duke University Medical Center, Durham, NC, 3Department of Medicine, Duke University Medical Center, Durham, NC
Meeting: 2020 American Transplant Congress
Abstract number: D-075
Keywords: Kidney transplantation, Outcome
Session Information
Session Name: Poster Session D: Kidney Technical
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: Textbook outcomes (TO) is an emerging concept in surgery, which represents an effort to define a standardized, composite quality metric based on multiple postoperative endpoints that represent the ideal “textbook” hospitalization. We defined TO for kidney transplantation (KTx) using a cohort from a high volume center.
*Methods: Patients who underwent KTx at our center between 2016-2019 were included. Pediatric and multiorgan recipients were excluded. TO was defined by expert consensus to include major intraoperative complication, Clavien-Dindo grade III complication (reintervention), 30-day ICU readmission, 30-day hospital readmission, hospital length of stay >75th percentile of all KTx patients, 90-day mortality, 30-day rejection, delayed graft function (DGF), and discharge with a Foley catheter. Recipient, operative, and financial characteristics were compared between TO and non-TO groups using Mann-Whitney U tests for continuous variables and Chi-squared and Fisher exact tests for categorical variables. Overall and rejection-free survival were estimated using the Kaplan Meier method.
*Results: A total of 181 KTx recipients were included. Of those, 69 (38%) achieved TO and 112 (62%) failed TO. Among patients who failed TO, the most common reasons for failure were hospital readmission (56%) and DGF (54%); the least common was mortality (4%) (Figure 1). TO failure was associated with black race (p=0.04), increased HLA mismatches (p<0.01), use of a right kidney graft (p=0.012), and higher total and transplant-related inpatient charges (p<0.0001, p=0.003; Figure 2). Overall and rejection-free survival were decreased among patients who failed TO (p=0.02, p=0.003). Among those with DGF, overall survival was preserved (p=0.6), however rejection-free survival was decreased (p=0.0018).
*Conclusions: At our center, TO in KTx was associated with favorable short term outcomes and significantly lower charges during the index hospitalization. Validation of this novel quality metric in a multicenter study is warranted.
To cite this abstract in AMA style:
Halpern SE, Moris D, Shaw BI, McElroy LM, Ellis MJ, Sudan D, Knechtle SJ, Collins BH, Barbas AS. Textbook Outcome: Definition and Analysis of a Novel Quality Measure in Kidney Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/textbook-outcome-definition-and-analysis-of-a-novel-quality-measure-in-kidney-transplantation/. Accessed May 17, 2025.« Back to 2020 American Transplant Congress