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
*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 December 1, 2023.
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