TY - JOUR
T1 - Failure to rescue as a quality improvement approach in transplantation
T2 - A first effort to evaluate this tool in pediatric liver transplantation
AU - Cramm, Shannon L.
AU - Waits, Seth A.
AU - Englesbe, Michael J.
AU - Bucuvalas, John C.
AU - Horslen, Simon P.
AU - Mazariegos, George V.
AU - Soltys, Kyle A.
AU - Anand, Ravinder
AU - Magee, John C.
N1 - Publisher Copyright:
© 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016
Y1 - 2016
N2 - Background. Significant intercenter variation exists inmortality 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 highmortality 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.
AB - Background. Significant intercenter variation exists inmortality 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 highmortality 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.
UR - http://www.scopus.com/inward/record.url?scp=84959155889&partnerID=8YFLogxK
U2 - 10.1097/TP.0000000000001121
DO - 10.1097/TP.0000000000001121
M3 - Article
C2 - 26910329
AN - SCOPUS:84959155889
SN - 0041-1337
VL - 100
SP - 801
EP - 807
JO - Transplantation
JF - Transplantation
IS - 4
ER -