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Columbo JA, Krafcik BM, Baughan E, Sickels AD, Beck AW, Neal D, Scali ST, Stone DH. Textbook outcomes as a novel patient-centric metric to inform carotid revascularization. J Vasc Surg 2025; 81:1370-1379.e2. [PMID: 39922241 PMCID: PMC12103996 DOI: 10.1016/j.jvs.2025.01.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 01/13/2025] [Accepted: 01/16/2025] [Indexed: 02/10/2025]
Abstract
OBJECTIVE The recent National Coverage Determination surrounding carotid stenting and shared decision-making has ushered in an era of patient-centric carotid care. However, historical carotid intervention endpoints have lacked patient-centered nuances to inform clinical decisions. Accordingly, we aimed to create a comprehensive novel, patient-centric textbook outcome (TO) to inform treatment paradigms. METHODS We developed a novel composite TO for patients who underwent carotid revascularization reflecting a combination of patient-centric outcomes derived from previous patient interviews and the published literature. We defined a TO to include freedom from postprocedural neurologic events, myocardial infarction, cranial nerve injury, return to the operating room, reperfusion syndrome, or access site complications. The endpoint also included discharge on postprocedural day 1, home discharge, and 30-day survival. We measured the risk of a TO vs non-TO among asymptomatic patients undergoing carotid endarterectomy (CEA), transcarotid artery revascularization (TCAR), or transfemoral carotid artery stenting (TF-CAS) in the Vascular Quality Initiative (VQI) from 2016 to 2023. RESULTS We studied 72,778 patients who underwent carotid revascularization, 70.3% CEA, 21.0% TCAR, and 8.7% TF-CAS. The mean age across all patients was 71.6 ± 8.4 years, 39.9% were female, and 91.7% were White. A TO was achieved in 76.9% of patients, and was 76.7% after CEA, 76.5% after TCAR, and 79.1% after TF-CAS (P < .001). Postprocedural length of stay was 2 days or more in 21.0% of patients, and was 21.1% after CEA, 21.6% after TCAR, and 18.4% after TF-CAS (P < .001). Postprocedural neurologic events occurred in 1.0% of patients after CEA, 1.3% after TCAR, and 1.4% after TF-CAS (P = .037). A sensitivity analysis of the TO that did not include postprocedural length of stay demonstrated a non-TO in 5.9% of patients after CEA, 5.5% after TCAR, and 6.3% after TF-CAS (P = .070). Patients who did not achieve a TO had inferior 5-year survival compared with patients who did have a TO across all three cohorts (log-rank P < .001). CONCLUSIONS This novel patient-centric endpoint demonstrated that a substantial percentage of patients fail to achieve a TO in current practice, and that failure to achieve a TO was associated with inferior 5-year survival. These findings are particularly important in light of the recent Medicare mandate for a shared decision-making approach to carotid care delivery and may help to best align patient preferences with procedure type.
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Affiliation(s)
- Jesse A Columbo
- Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
| | - Brianna M Krafcik
- Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | | | - Angela D Sickels
- Division of Vascular and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Adam W Beck
- Division of Vascular and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Dan Neal
- Division of Vascular and Endovascular Therapy, University of Florida Medical Center, Gainesville, FL
| | - Salvatore T Scali
- Division of Vascular and Endovascular Therapy, University of Florida Medical Center, Gainesville, FL; University of Florida School of Medicine, Gainesville, FL
| | - David H Stone
- Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH
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Zhong SY, Gao SY, Jiang Y, Luo YL, Gong Y, Yu T, Yin XY, Liu XC, Fan HN, Pang SJ, Bai J, Dai HS, Chen ZY, Zhang YQ, Liu ZP, Wang HQ. Association between the Achievement of Textbook Outcomes in Liver Surgery and Overall Survival in Perihilar Cholangiocarcinoma Patients following Major Hepatectomy: A Multicenter Study. Dig Dis 2025; 43:179-189. [PMID: 39778550 DOI: 10.1159/000543439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 01/06/2025] [Indexed: 01/11/2025]
Abstract
INTRODUCTION Major hepatectomy is the mainstay of curative-intent resection for perihilar cholangiocarcinoma (pCCA) patients. Textbook outcomes in liver surgery (TOLS) are a new composite parameter for evaluating the short-term outcomes of surgery; however, their association with overall survival (OS) is unknown. Therefore, this study aimed to investigate the association between TOLS and OS in pCCA patients following major hepatectomy. METHODS Consecutive pCCA patients who underwent major hepatectomy between 2014 and 2020 at 5 hospitals were included in this analysis. TOLS were defined as no intraoperative grade ≥2 incidents, no postoperative grade B/C bile leakage, no postoperative grade B/C liver failure, no postoperative major morbidity, no readmission within 90 days due to surgery-related major morbidity, no mortality within 90 days after hospital discharge, and R0 resection. The Kaplan-Meier method was used to compare OS rates between patients who achieved TOLS and those who did not. Cox regression analysis was used to identify independent risk factors for poor OS. RESULTS In total, 399 patients were included in this study, 214 (53.6%) of whom achieved TOLS. After excluding patients who died within 90 days, the 5-year OS rate of patients who achieved TOLS was significantly greater than that of patients who did not achieve TOLS (5-year OS rate: 26.2% vs. 17.3%, p = 0.001). TOLS were independently associated with OS for pCCA patients following major hepatectomy. CONCLUSIONS TOLS were achieved in approximately half of the pCCA patients following major hepatectomy, and the patients who achieved TOLS had better survival.
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Affiliation(s)
- Shi-Yun Zhong
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Shu-Yang Gao
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yan Jiang
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yu-Le Luo
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yi Gong
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Ting Yu
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xian-Yu Yin
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xing-Chao Liu
- Department of Hepatobiliary Surgery, Sichuan Provincial People's Hospital, Chengdu, China
| | - Hai-Ning Fan
- Department of Hepato-pancreato-biliary Surgery, the Qinghai University Affiliated Hospital, The Research Key Laboratory for Echinococcosis of Qinghai Province, Xining, China
| | - Shu-Jie Pang
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Jie Bai
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Hai-Su Dai
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zhi-Yu Chen
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yan-Qi Zhang
- Department of Health Statistics, College of Military Preventive Medicine, Army Medical University, Chongqing, China
| | - Zhi-Peng Liu
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
- Hepato-Pancreato-Biliary Center, Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Hua-Qiang Wang
- Department of Hepatobiliary Surgery, Nanchuan District People's Hospital, Chongqing, China
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Görtzen DQ, Sampon F, Timmermans N, Ter Woorst J, Akca F. Endoscopic-assisted, minimally invasive versus sternotomy total arterial multivessel bypass grafting. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 39:ivae187. [PMID: 39540774 PMCID: PMC11590249 DOI: 10.1093/icvts/ivae187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 10/28/2024] [Accepted: 11/12/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVES This single-centre study compared the perioperative outcomes after total arterial multivessel revascularization through endoscopic-assisted, minimally invasive surgery compared to a conventional sternotomy approach. METHODS In this retrospective, propensity score-matched (PSM) cohort study, a total of 740 patients were analysed [endoscopic coronary artery bypass grafting (Endo-CAB), N = 92; Sternotomy, N = 648]. After PSM (1:2 ratio), 73 Endo-CAB and 137 sternotomy patients were compared with an equal number of distal anastomoses (Endo-CAB 2.3 versus Sternotomy 2.4 anastomoses per patient, P = 0.082). We used 'textbook outcome' as a patient-orientated outcome measure, defined as the absence of 30-day mortality, re-exploration for bleeding, postoperative ischaemia, cardiac tamponade, cerebrovascular events, wound infection, new onset arrhythmias, pneumonia, placement of chest drains and prolonged hospital stay (>7 days). RESULTS Patients undergoing Endo-CAB had significantly more often a textbook outcome compared to the sternotomy group (78.1% vs 59.1%, P = 0.009). Endo-CAB patients had shorter hospital stay (4.0 vs 6.0 days, P < 0.001), less postoperative blood loss (360 vs 490 ml, P < 0.001) and a significant reduction of new onset postoperative atrial fibrillation (5.5% vs 17.5%, P = 0.015). Other postoperative outcomes were comparable for both groups. CONCLUSIONS Total arterial Endo-CAB demonstrates excellent postoperative outcomes compared to a sternotomy approach for multivessel coronary artery disease. These findings provide a strong basis for further expanding the multivessel Endo-CAB programme.
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Affiliation(s)
- De Qing Görtzen
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands
| | - Fleur Sampon
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands
| | - Naomi Timmermans
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands
| | - Joost Ter Woorst
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands
| | - Ferdi Akca
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands
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Martinino A, Ladowski JM, Schilirò D, Hartwig MG, Moris D, Barbas AS. Textbook Outcomes in Solid Transplantation: A Systematic Review. Transplant Direct 2024; 10:e1694. [PMID: 39301557 PMCID: PMC11410326 DOI: 10.1097/txd.0000000000001694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/17/2024] [Accepted: 07/05/2024] [Indexed: 09/22/2024] Open
Abstract
Background The concept of TO is expanding across various surgical disciplines to establish a standardized, comprehensive quality benchmark. Traditional metrics such as 1-y patient and graft survival have been key for evaluating transplant program performance but are now deemed inadequate because of significant field advancements. This systematic review aims to provide a comprehensive understanding of the applicability and validity of textbook outcome (TO) in the setting of solid organ transplantation. Methods A structured search, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted across PubMed, Embase, and Scopus databases on March 10, 2024. Results Fourteen articles were identified for inclusion in this review. Of these, 2 studies addressed TO in heart transplantation, 3 in lung transplantation, 2 in kidney transplantation, and 7 in liver transplantation. A subgroup analysis was conducted to categorize the different definitions of TOs and identify the most common reasons for TO failure. Conclusions Our systematic review highlights the ongoing efforts in the field of solid organ transplantation to define TO and emphasizes the importance of developing a universally recognized set of TO criteria for each type of transplant. TO provides a valuable framework for transplant centers to benchmark their performance against similar institutions on a risk-adjusted basis and to pinpoint specific areas for enhancing patient outcomes. Even the most successful programs may discover aspects within the composite outcome with scope for improvement.
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Affiliation(s)
| | | | - Davide Schilirò
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Dimitrios Moris
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Andrew S. Barbas
- Department of Surgery, Duke University Medical Center, Durham, NC
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Sampon F, Ter Woorst J, Dekker L, Akca F. Thoracoscopic-assisted, minimally invasive versus off-pump bypass grafting for single vessel coronary artery disease - A propensity matched analysis. Int J Cardiol 2024; 409:132175. [PMID: 38754586 DOI: 10.1016/j.ijcard.2024.132175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE This study compared perioperative outcomes after off-pump revascularization through a thoracoscopic-assisted (non-robotic) minimally invasive approach (Endo-CAB) or sternotomy approach (OPCAB) for patients with single vessel left anterior descending (LAD) disease. METHODS In this retrospective, propensity matched cohort study, 266 consecutive patients were included in the Endo-CAB group (n = 136) and OPCAB group (n = 130). After propensity score matching 116 Endo-CAB and 116 OPCAB patients were compared. 'Textbook outcome' was defined as the absence of 30-day mortality, re-exploration for bleeding, postoperative ischemia, cardiac tamponade, cerebrovascular events, wound infection, new-onset arrhythmias, pneumonia, placement of chest drains and prolonged hospital stay (> 7 days). Multivariable regression analysis was performed to identify independent predictors for textbook outcome. RESULTS Textbook outcome occurred significantly more frequent in the Endo-CAB group compared to the OPCAB group (81.9% vs. 59.5%, p < 0.001). Patients undergoing Endo-CAB surgery had shorter hospital admission (3.0 [3.0-4.0] vs. 5.0 [4.0-6.0] days, p < 0.001), less blood loss (225 [150-355] vs. 450 [350-600] mL, p < 0.001). Other perioperative outcomes were comparable for both groups. Regression analysis demonstrated that Endo-CAB approach was an independent positive predictor for textbook outcome (OR 3.02, 95% CI 1.61-5.66, p < 0.001). CONCLUSIONS Our study suggests that patients undergoing Endo-CAB surgery have improved perioperative outcome resulting in higher rates of textbook outcome for the treatment of single vessel CAD. This technique could be widely available since routine thoracoscopic instruments are used.
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Affiliation(s)
- Fleur Sampon
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Joost Ter Woorst
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Lukas Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Departments of Biomedical Technology, Eindhoven University of Technology, the Netherlands
| | - Ferdi Akca
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands.
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Nicolazzi M, Di Martino M, Baroffio P, Donadon M. 6,126 hepatectomies in 2022: current trend of outcome in Italy. Langenbecks Arch Surg 2024; 409:211. [PMID: 38985363 PMCID: PMC11236879 DOI: 10.1007/s00423-024-03398-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/26/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE Whether hospital volume affects outcome of patients undergoing hepatobiliary surgery, and whether the centralization of such procedures is justified remains to be investigated. The aim of this study was to analyze the outcome of liver surgery in Italy in relationship of hospital volume. METHODS This is a nationwide retrospective observational study conducted on data collected by the National Italian Registry "Piano Nazionale Esiti" (PNE) 2023 that included all liver procedures performed in 2022. Outcome measure were case volume and 30-day mortality. Hospitals were classified as very high-volume (H-Vol), intermediate-volume (I-Vol), low-volume (L-Vol) and very low-volume (VL-VoL). A review on centralization process and outcome measures was added. RESULTS 6,126 liver resections for liver tumors were performed in 327 hospitals in 2022. The 30-day mortality was 2.2%. There were 14 H-Vol, 19 I-Vol, 31 L-Vol and 263 VL-Vol hospitals with 30-day mortality of 1.7%, 2.2%, 2.6% and 3.6% respectively (P < 0.001); 220 centers (83%) performed less than 10 resections, and 78 (29%) centers only 1 resection in 2022. By considering the geographical macro-areas, the median count of liver resection performed in northern Italy exceeded those in central and southern Italy (57% vs. 23% vs. 20%, respectively). CONCLUSIONS High-volume has been confirmed to be associated to better outcome after hepatobiliary surgical procedures. Further studies are required to detail the factors associated with mortality. The centralization process should be redesigned and oversight.
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Affiliation(s)
- Marco Nicolazzi
- Department of Health Sciences, University of Piemonte Orientale, Novara, 28100, Italy
- Department of Surgery, University Maggiore Hospital della Carità, Corso Mazzini 18, Novara, 28100, Italy
| | - Marcello Di Martino
- Department of Health Sciences, University of Piemonte Orientale, Novara, 28100, Italy
- Department of Surgery, University Maggiore Hospital della Carità, Corso Mazzini 18, Novara, 28100, Italy
| | - Paolo Baroffio
- Department of Surgery, University Maggiore Hospital della Carità, Corso Mazzini 18, Novara, 28100, Italy
| | - Matteo Donadon
- Department of Health Sciences, University of Piemonte Orientale, Novara, 28100, Italy.
- Department of Surgery, University Maggiore Hospital della Carità, Corso Mazzini 18, Novara, 28100, Italy.
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Rompianesi G, Montalti R, Vrakas G, Zarrinpar A, Warren C, Loiaco G, Rubba F, Troisi RI. Benchmark Outcomes in Deceased Donor Kidney Transplantation: A Multicenter Analysis of 80 996 Transplants From 126 Centers. Transplant Direct 2024; 10:e1618. [PMID: 38606349 PMCID: PMC11005896 DOI: 10.1097/txd.0000000000001618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND We defined clinically relevant benchmark values in deceased donor kidney transplantation (KT), to assess the best achievable results in low-risk patient cohorts from experienced centers. METHODS We identified the "ideal" cases from the United Network for Organ Sharing Standard Transplant Analysis and Research files from centers performing ≥50 KT per year between 2010 and 2018. Cases have been selected based on the kidney donor profile index values (<35%), a cold ischemia time (CIT) ≤18 h, a HLA mismatch ≤4, and excluding blood group (ABO) incompatible, dual and combined transplants. The outcomes of the benchmark cohort have been compared with a group of patients excluded from the benchmark cohort because but not meeting 1 or more of the abovementioned criteria. RESULTS The 171 424 KT patients in the United Network for Organ Sharing Standard Transplant Analysis and Research files were screened and 8694 benchmark cases of a total of 80 996 KT (10.7%) from 126 centers meeting the selection criteria were identified. The benchmarks for 1-, 3-, and 5-y patient survival are ≥97%, ≥92.5%, and ≥86.7%, and ≥95.4%, ≥87.8%, and ≥79.6% for graft survival. Benchmark cutoff for hospital length of stay is ≤5 d, ≤23.6% for delayed graft function, and ≤7.5% and ≤9.1% for 6-mo and 1-y incidence of acute rejection. Overall 1-, 3-, and 5-y actuarial graft survivals were 96.6%, 91.1%, and 84.2% versus 93.5%, 85.4%, and 75.5% in the benchmark and comparison groups, respectively (P < 0.001). Overall 1-, 3-, and 5-y actuarial patient survivals were 98.1%, 94.8%, and 90.0% versus 96.6%, 91.1%, and 83.0% in the benchmark and comparison groups, respectively (P < 0.001). CONCLUSIONS For the first time, we quantified the best achievable postoperative results in an ideal scenario in deceased donor KT, aimed at improving the clinical practice guided by the comparison of center performances with the ideal outcomes defined.
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Affiliation(s)
- Gianluca Rompianesi
- Division of Hepato-Biliary-Pancreatic, Minimally Invasive, Robotic Surgery and Kidney Transplantation, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Italy
| | - Roberto Montalti
- Division of Hepato-Biliary-Pancreatic, Minimally Invasive, Robotic Surgery and Kidney Transplantation, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Italy
| | - Georgios Vrakas
- Department of Surgery, University of Florida, Gainesville, FL
| | - Ali Zarrinpar
- Department of Surgery, University of Florida, Gainesville, FL
| | - Curtis Warren
- Department of Surgery, University of Florida, Gainesville, FL
| | - Giuseppe Loiaco
- Division of Hepato-Biliary-Pancreatic, Minimally Invasive, Robotic Surgery and Kidney Transplantation, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Italy
| | - Fabiana Rubba
- Public Health Department, Federico II University Hospital, Naples, Italy
| | - Roberto I. Troisi
- Division of Hepato-Biliary-Pancreatic, Minimally Invasive, Robotic Surgery and Kidney Transplantation, Department of Clinical Medicine and Surgery, Federico II University Hospital of Naples, Italy
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Prabhu NK, Moya-Mendez ME, Kang L, Medina CK, McCrary AW, Allareddy V, Overbey D, Turek JW. Textbook Outcome for Superior Cavopulmonary Connection: A Metric for Single Ventricle Heart Surgery. World J Pediatr Congenit Heart Surg 2024; 15:303-312. [PMID: 38263731 DOI: 10.1177/21501351231215261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Background: To develop a more holistic measure of congenital heart center performance beyond mortality, we created a composite "textbook outcome" (TO) for the Glenn operation. We hypothesized that meeting TO would have a positive prognostic and financial impact. Methods: This was a single center retrospective study of patients undergoing superior cavopulmonary connection (bidirectional Glenn or Kawashima ± concomitant procedures) from 2005 to 2021. Textbook outcome was defined as freedom from operative mortality, reintervention, 30-day readmission, extracorporeal membrane oxygenation, major thrombotic complication, length of stay (LOS) >75th percentile (17d), and mechanical ventilation duration >75th percentile (2d). Multivariable logistic regression and Cox proportional hazards modeling were used. Results: Fifty-one percent (137/269) of patients met TO. Common reasons for TO failure were prolonged LOS (78/132, 59%) and ventilator duration (67/132, 51%). In multivariable analysis, higher weight [odds ratio, OR: 1.44 (95% confidence interval, CI: 1.15-1.84), P = .002] was a positive predictor of TO achievement while right ventricular dominance [OR 0.47 (0.27-0.81), P = .007] and higher preoperative pulmonary vascular resistance [OR 0.58 (0.40-0.82), P = .003] were negative predictors. After controlling for preoperative factors and excluding operative mortalities, TO achievement was independently associated with a decreased risk of death over long-term follow-up [hazard ratio: 0.50 (0.25-0.99), P = .049]. Textbook outcome achievement was also associated with lower direct cost of care [$137,626 (59,333-167,523) vs $262,299 (114,200-358,844), P < .0001]. Conclusion: Achievement of the Glenn TO is associated with long-term survival and lower costs and can be predicted by certain risk factors. As outcomes continue to improve within congenital heart surgery, operative mortality will become a less informative metric. Textbook outcome analysis may represent a more balanced measure of a successful outcome.
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Affiliation(s)
- Neel K Prabhu
- Congenital Heart Surgery Research and Training Laboratory, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Mary E Moya-Mendez
- Congenital Heart Surgery Research and Training Laboratory, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Lillian Kang
- Congenital Heart Surgery Research and Training Laboratory, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Cathlyn K Medina
- Congenital Heart Surgery Research and Training Laboratory, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Andrew W McCrary
- Duke Children's Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC, USA
| | - Veerajalandhar Allareddy
- Duke Children's Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC, USA
| | - Douglas Overbey
- Congenital Heart Surgery Research and Training Laboratory, Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Children's Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC, USA
| | - Joseph W Turek
- Congenital Heart Surgery Research and Training Laboratory, Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Children's Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC, USA
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Zakko J, Premkumar A, Logan AJ, Sneddon JM, Brock GN, Pawlik TM, Mokadam NA, Whitson BA, Lampert BC, Washburn WK, Osho AA, Ganapathi AM, Schenk AD. Textbook outcome: A novel metric in heart transplantation outcomes. J Thorac Cardiovasc Surg 2024; 167:1077-1087.e13. [PMID: 36990918 DOI: 10.1016/j.jtcvs.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/17/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Assessing heart transplant program quality using short-term survival is insufficient. We define and validate the composite metric textbook outcome and examine its association with overall survival. METHODS We identified all primary, isolated adult heart transplants in the United Network for Organ Sharing/Organ Procurement and Transplantation Network Standard Transplant Analysis and Research files from May 1, 2005, to December 31, 2017. Textbook outcome was defined as length of stay 30 days or less; ejection fraction greater than 50% during 1-year follow-up; functional status 80% to 100% at 1 year; freedom from acute rejection, dialysis, and stroke during the index hospitalization; and freedom from graft failure, dialysis, rejection, retransplantation, and mortality during the first year post-transplant. Univariate and multivariate analyses were performed. Factors independently associated with textbook outcome were used to create a predictive nomogram. Conditional survival at 1 year was measured. RESULTS A total of 24,620 patients were identified with 11,169 (45.4%, 95% confidence interval, 44.7-46.0) experiencing textbook outcome. Patients with textbook outcome were more likely free from preoperative mechanical support (odds ratio, 3.504, 95% confidence interval, 2.766 to 4.439, P < .001), free from preoperative dialysis (odds ratio, 2.295, 95% confidence interval, 1.868-2.819, P < .001), to be not hospitalized (odds ratio, 1.264, 95% confidence interval, 1.183-1.349, P < .001), to be nondiabetic (odds ratio, 1.187, 95% confidence interval, 1.113-1.266, P < .001), and to be nonsmokers (odds ratio, 1.160, 95% confidence interval,1.097-1.228, P < .001). Patients with textbook outcome have improved long-term survival relative to patients without textbook outcome who survive at least 1 year (hazard ratio for death, 0.547, 95% confidence interval, 0.504-0.593, P < .001). CONCLUSIONS Textbook outcome is an alternative means of examining heart transplant outcomes and is associated with long-term survival. The use of textbook outcome as an adjunctive metric provides a holistic view of patient and center outcomes.
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Affiliation(s)
- Jason Zakko
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - April J Logan
- Division of Transplant Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey M Sneddon
- Division of Transplant Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Guy N Brock
- Division of Transplant Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Timothy M Pawlik
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nahush A Mokadam
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bryan A Whitson
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Brent C Lampert
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - William K Washburn
- Division of Transplant Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Asishana A Osho
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Asvin M Ganapathi
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Austin D Schenk
- Division of Transplant Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Bobrzynski L, Sędłak K, Rawicz-Pruszyński K, Kolodziejczyk P, Szczepanik A, Polkowski W, Richter P, Sierzega M. Evaluation of optimum classification measures used to define textbook outcome among patients undergoing curative-intent resection of gastric cancer. BMC Cancer 2023; 23:1199. [PMID: 38057839 DOI: 10.1186/s12885-023-11695-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Textbook outcome (TO) is a composite measure reflecting various aspects of services provided to patients with solid malignancies. We sought to evaluate the importance of various TO components previously proposed for gastric cancer. METHODS Prospectively maintained electronic databases of 1,743 patients treated in two academic surgical centres were reviewed. Six candidate definitions of TO were evaluated based on their ability to accurately predict patients' prognosis by Cox proportional hazards modelling. RESULTS TO definition combining 10 measures corresponding to complete tumour resection with an uneventful postoperative course showed the best goodness of fit by achieving the lowest values of Akaike (AIC) and Bayesian (BIC) information criteria and the best predictive performance based on the highest value of c-index. The overall median survival was significantly longer for patients with than without textbook outcome (69.0 vs 20.1 months, P < 0.001). TO maintained its prognostic value in a multivariate model controlling for age, sex, comorbidities, treatment, and tumour related variables and was associated with a 39% lower risk of death (HR 0.61, 95%CI 0.51 - 0.73, P < 0.001). Nine variables identified as predictors of TO were used to develop a nomogram showing very good correlation between the predicted and actual probability of achieving TO. The AUC of ROC obtained from the nomogram was 0.752 (95% CI 0.727 to 0.781). CONCLUSIONS A uniform definition of textbook outcome provides clinically relevant prognostic information and could be used in quality improvement programs for gastric cancer patients.
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Affiliation(s)
- L Bobrzynski
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow, 30-688, Poland
| | - K Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - K Rawicz-Pruszyński
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - P Kolodziejczyk
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow, 30-688, Poland
| | - A Szczepanik
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow, 30-688, Poland
| | - W Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - P Richter
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow, 30-688, Poland
| | - M Sierzega
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow, 30-688, Poland.
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11
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Prabhu NK, Nellis JR, Moya-Mendez M, Hoover A, Medina C, Meza JM, Allareddy V, Andersen ND, Turek JW. Textbook outcome for the Norwood operation-an informative quality metric in congenital heart surgery. JTCVS OPEN 2023; 15:394-405. [PMID: 37808016 PMCID: PMC10556845 DOI: 10.1016/j.xjon.2023.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 10/10/2023]
Abstract
Objectives To develop a more holistic measure of center performance than operative mortality, we created a composite "textbook outcome" for the Norwood operation using several postoperative end points. We hypothesized that achieving the textbook outcome would have a positive prognostic and financial impact. Methods This was a single-center retrospective study of primary Norwood operations from 2005 to 2021. Through interdisciplinary clinician consensus, textbook outcome was defined as freedom from operative mortality, open or catheter-based reintervention, 30-day readmission, extracorporeal membrane oxygenation, cardiac arrest, reintubation, length of stay >75%ile from Society of Thoracic Surgeons data report (66 days), and mechanical ventilation duration >75%ile (10 days). Multivariable logistic regression and Cox proportional hazards modeling were used to determine predictive factors for textbook outcome achievement and association of the outcome with long-term survival, respectively. Results Overall, 30% (58/196) of patients met the textbook outcome. Common reasons for failure to attain textbook outcome were prolonged ventilation (68/138, 49%) and reintubation (63/138, 46%). In multivariable analysis, greater weight (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.17-3.95; P = .02) was associated with achieving the textbook outcome whereas preoperative shock (OR, 0.36; 95% CI, 0.13-0.87; P = .03) and longer bypass time (OR, 0.99; 95% CI, 0.98-1.00; P = .002) were negatively associated. Patients who met the outcome incurred fewer hospital costs ($152,430 [141,798-177,983] vs $269,070 [212,451-372,693], P < .001), and after adjusting for patient factors, achieving textbook outcome was independently associated with decreased risk of all-cause mortality (hazard ratio, 0.45; 95% CI, 0.22-0.89; P = .02). Conclusions Outcomes continue to improve within congenital heart surgery, making operative mortality a less-sensitive metric. The Norwood textbook outcome may represent a balanced measure of a successful episode of care.
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Affiliation(s)
- Neel K. Prabhu
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC
| | - Joseph R. Nellis
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC
| | - Mary Moya-Mendez
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC
| | - Anna Hoover
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC
| | - Cathlyn Medina
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC
| | - James M. Meza
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC
| | - Veerajalandhar Allareddy
- Duke Children's Pediatric and Congenital Heart Center, Durham, NC
- Division of Critical Care Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Nicholas D. Andersen
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC
- Duke Children's Pediatric and Congenital Heart Center, Durham, NC
| | - Joseph W. Turek
- Congenital Heart Surgery Research and Training Laboratory, Duke University, Durham, NC
- Duke Children's Pediatric and Congenital Heart Center, Durham, NC
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12
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Carbonell-Morote S, Ortiz-Sebastián S, Estrada-Caballero JL, Gracia-Alegria E, Ruiz de la Cuesta Tapia E, Villodre C, Campo-Betancourth CF, Rubio-García JJ, Velilla-Vico D, Ramia JM. Textbook Outcome in Bariatric Surgery: Evolution During 15 Years in a Referral Center. J Gastrointest Surg 2023; 27:1578-1586. [PMID: 37227607 DOI: 10.1007/s11605-023-05690-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/10/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Textbook outcome (TO) is a multidimensional measure used to assess the quality of care. It is the "ideal" surgical result, based on a series of established indicators. In the field of bariatric surgery (BS), only one publication on TO is available. OBJECTIVES To determine TO in our BS unit and identify the factors linked to TO. SETTING University public hospital in Alicante (Spain). METHODS Retrospective observational study of all primary BS was performed. TO for BS was defined in relation to the following features: no major postoperative complications (Clavien-Dindo >II), hospital stay <75th percentile, and no mortality or readmissions within 30 days of surgery. Comparative analysis of the characteristics of the TO and non-TO groups was performed, as well as univariate and multivariate logistic regressions, to identify the independent factors associated with obtaining TO. RESULTS In 970 patients, TO was achieved in 71.5%. The hospital stay was the one that most affected achievement of TO. Analysis according to the type of procedure (sleeve gastrectomy and gastric bypass) did not reveal any differences between both procedures in terms of obtaining TO (71.5 vs 71.26%). Logistic regression identified smoking, heart disease, operative time, and upper gastrointestinal bleeding as independent factors associated with obtaining TO (p<0.05). Analysis of the annual evolution of TO reveals a progressive increase in its achievement (7.7-86.4%). CONCLUSION In our series, TO was obtained in 71.5% of patients. The standardization of the technique and the experience gained over the years has improved our TO results.
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Affiliation(s)
- Silvia Carbonell-Morote
- Department of Surgery, Hospital General Universitario Dr. Balmis, Pintor Baeza 11, 03010, Alicante, Spain.
- ISABIAL, Alicante, Spain.
| | - Sergio Ortiz-Sebastián
- Department of Surgery, Hospital General Universitario Dr. Balmis, Pintor Baeza 11, 03010, Alicante, Spain
- ISABIAL, Alicante, Spain
| | - José Luis Estrada-Caballero
- Department of Surgery, Hospital General Universitario Dr. Balmis, Pintor Baeza 11, 03010, Alicante, Spain
- ISABIAL, Alicante, Spain
| | - Ester Gracia-Alegria
- Department of Surgery, Hospital General Universitario Dr. Balmis, Pintor Baeza 11, 03010, Alicante, Spain
- ISABIAL, Alicante, Spain
| | - Emilio Ruiz de la Cuesta Tapia
- Department of Surgery, Hospital General Universitario Dr. Balmis, Pintor Baeza 11, 03010, Alicante, Spain
- ISABIAL, Alicante, Spain
| | - Celia Villodre
- Department of Surgery, Hospital General Universitario Dr. Balmis, Pintor Baeza 11, 03010, Alicante, Spain
- ISABIAL, Alicante, Spain
- Universidad Miguel Hernández, Alicante, Spain
| | | | - Juan Jesus Rubio-García
- Department of Surgery, Hospital General Universitario Dr. Balmis, Pintor Baeza 11, 03010, Alicante, Spain
- ISABIAL, Alicante, Spain
| | - David Velilla-Vico
- Department of Surgery, Hospital General Universitario Dr. Balmis, Pintor Baeza 11, 03010, Alicante, Spain
- ISABIAL, Alicante, Spain
| | - José Manuel Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, Pintor Baeza 11, 03010, Alicante, Spain
- ISABIAL, Alicante, Spain
- Universidad Miguel Hernández, Alicante, Spain
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13
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Bakhtiyar SS, Sakowitz S, Ali K, Coaston T, Verma A, Chervu NL, Benharash P. Textbook outcomes in heart transplantation: A quality metric for the modern era. Surgery 2023:S0039-6060(23)00160-5. [PMID: 37120382 DOI: 10.1016/j.surg.2023.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/02/2023] [Accepted: 03/21/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Traditional quality metrics like one-year survival do not fully encapsulate the multifaceted nature of solid organ transplantation in contemporary practice. Therefore, investigators have proposed using a more comprehensive measure, the textbook outcome. However, the textbook outcome remains ill-defined in the setting of heart transplantation. METHODS Within the Organ Procurement and Transplantation Network database, the textbook outcome was defined as having: (1) No postoperative stroke, pacemaker insertion, or dialysis, (2) no extracorporeal membrane oxygenation requirement within 72 hours of transplantation, (3) index length of stay <21 days, (4) no acute rejection or primary graft dysfunction, (5) no readmission for rejection or infection, or re-transplantation within one year, and (6) an ejection fraction >50% at one year. RESULTS Of 26,885 heart transplantation recipients between 2011 to 2022, 9,841 (37%) achieved a textbook outcome. Following adjustment, textbook outcome patients demonstrated significantly reduced hazard of mortality at 5- (hazard ratio 0.71, 95% CI 0.65-0.78; P < .001) and 10-years (hazard ratio 0.73, CI 0.68-0.79; P < .001), and significantly greater likelihood of graft survival at 5- (hazard ratio 0.69, CI 0.63-0.75; P < .001) and 10-years (hazard ratio 0.72, CI 0.67-0.77; P < .001). Following estimation of random effects, hospital-specific, risk-adjusted rates of textbook outcome ranged from 39% to 91%, compared to a range of 97% to 99% for one-year patient survival. Multi-level modeling of post-transplantation rates of textbook outcomes revealed that 9% of the variation between transplant programs was attributable to inter-hospital differences. CONCLUSION Textbook outcomes offer a nuanced, composite alternative to using one-year survival when evaluating heart transplantation outcomes and comparing transplant program performance.
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Affiliation(s)
- Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA; Department of Surgery, University of Colorado, Aurora, CO
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA
| | - Konmal Ali
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA
| | - Troy Coaston
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA
| | - Nikhil L Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA; Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, CA.
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14
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Moris D, McElroy LM, Barbas AS. Can the Concept of Textbook Outcomes Be Applicable to Organ Transplantation? EXP CLIN TRANSPLANT 2023; 21:380-381. [PMID: 33797356 DOI: 10.6002/ect.2020.0417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Dimitrios Moris
- From the Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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15
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Fallani G, Maroni L, Bonatti C, Comai G, Buzzi M, Cuna V, Vasuri F, Caputo F, Prosperi E, Pisani F, Pisillo B, Maurino L, Odaldi F, Bertuzzo VR, Tondolo F, Busutti M, Zanfi C, Del Gaudio M, La Manna G, Ravaioli M. Renal Vessel Extension With Cryopreserved Vascular Grafts: Overcoming Surgical Pitfalls in Living Donor Kidney Transplant. Transpl Int 2023; 36:11060. [PMID: 36846603 PMCID: PMC9950096 DOI: 10.3389/ti.2023.11060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/26/2023] [Indexed: 02/12/2023]
Abstract
In LDKT, right kidneys and kidneys with anomalous vascularization are often deferred because of concerns on complications and vascular reconstructions. To date, only few reports have examined renal vessel extension with cryopreserved vascular grafts in LDKT. The aim of this study is to investigate the effect of renal vessel extension on short-term outcomes and ischemia times in LDKT. From 2012 to 2020, recipients of LDKT with renal vessels extension were compared with standard LDKT recipients. Subset analysis of rights grafts and grafts with anomalous vascularization, with or without renal vessel extension, was performed. Recipients of LDKT with (n = 54) and without (n = 91) vascular extension experienced similar hospital stays, surgical complications and DGF rates. For grafts with multiple vessels, renal vessel extension granted a faster implantation time (44±5 vs. 72±14 min), which resulted comparable to that of standard anatomy grafts. Right kidney grafts with vascular extension had a faster implantation time compared to right kidney grafts without vascular lengthening (43±5 vs. 58±9 min), and a comparable implantation time to left kidney grafts. Renal vessel extension with cryopreserved vascular grafts allows faster implantation time in right kidney grafts or grafts with anomalous vascularization, maintaining similar surgical and functional outcomes.
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Affiliation(s)
- Guido Fallani
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Maroni
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Chiara Bonatti
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giorgia Comai
- Department of Nephrology, Dialysis and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marina Buzzi
- Tissue Bank, Department of Immunohematology and Transfusion Medicine, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vania Cuna
- Department of Nephrology, Dialysis and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Vasuri
- Department of Pathology, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesca Caputo
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Enrico Prosperi
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federico Pisani
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Beatrice Pisillo
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ludovica Maurino
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federica Odaldi
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valentina Rosa Bertuzzo
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Tondolo
- Department of Nephrology, Dialysis and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Busutti
- Department of Nephrology, Dialysis and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Chiara Zanfi
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Massimo Del Gaudio
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gaetano La Manna
- Department of Nephrology, Dialysis and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Matteo Ravaioli
- Department of Hepatobiliary Surgery and Transplantation, Policlinico S. Orsola-Malpighi, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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16
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Textbook Outcome of Laparoscopic Microwave Ablation for Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:cancers15020436. [PMID: 36672385 PMCID: PMC9856576 DOI: 10.3390/cancers15020436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/28/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023] Open
Abstract
In the context of spreading interest in textbook outcome (TO) evaluation in different fields, we aimed to investigate an uncharted procedure, that is, laparoscopic microwave ablation (MWA) for hepatocellular carcinoma (HCC). Absence of post-MWA complications, a hospital stay of three days, no mortality nor readmission within 30 days, and complete response of the target lesion at post-MWA CT scan defined TO achievement. Patients treated between January 2014 and March 2021 were retrospectively reviewed, and of the 521 patients eligible for the study, 337 (64.7%) fulfilled all the quality indicators to achieve the TO. The absence of complications was the main limiting factor for accomplishing TO. At multivariable analysis, Child-Pugh B cirrhosis, age of more than 70 years old, three nodules, and MELD score ≥ 15 were associated with decreased probabilities of TO achievement. A score based on these factors was derived from multivariable analysis, and patients were divided into three risk groups for TO achievement. At survival analysis, overall survival (OS) was significantly (p = 0.001) higher in patients who achieved TO than those who did not. Moreover, OS evaluation in the three risk groups showed a trend coherent with TO achievement probability. The present study, having assessed the first TO for laparoscopic MWA for HCC, encourages further broader consensus on its definition and, on its basis, on the development of clinically relevant tools for managing treatment allocation.
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Abstract
BACKGROUND Quality in kidney transplantation is measured using 1-year patient and graft survival. Because 1-year patient and graft survival exceed 95%, this metric fails to measure a spectrum of quality. Textbook outcomes (TO) are a composite quality metric offering greater depth and resolution. We studied TO after living donor (LD) and deceased donor (DD) kidney transplantation. STUDY DESIGN United Network for Organ Sharing data for 69,165 transplant recipients between 2013 and 2017 were analyzed. TO was defined as patient and graft survival of 1 year or greater, 1-year glomerular filtration rate of greater than 40 mL/min, absence of delayed graft function, length of stay of 5 days or less, no readmissions during the first 6 months, and no episodes of rejection during the first year after transplantation. Bivariate analysis identified characteristics associated with TO, and covariates were incorporated into multivariable models. Five-year conditional survival was measured, and center TO rates were corrected for case complexity to allow center-level comparisons. RESULTS The national average TO rates were 54.1% and 31.7% for LD and DD transplant recipients. The hazard ratio for death at 5 years for recipients who did not experience TO was 1.92 (95% CI 1.68 to 2.18, p ≤ 0.0001) for LD transplant recipients and 2.08 (95% CI 1.93 to 2.24, p ≤ 0.0001) for DD transplant recipients. Center-level comparisons identify 18% and 24% of centers under-performing in LD and DD transplantation. High rates of TO do not correlate with transplantation center volume. CONCLUSION Kidney transplant recipients who experience TO have superior long-term survival. Textbook outcomes add value to the current standards of 1-year patient and graft survival.
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18
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Krischak MK, Au S, Halpern SE, Olaso DG, Moris D, Snyder LD, Barbas AS, Haney JC, Klapper JA, Hartwig MG. Textbook surgical outcome in lung transplantation: Analysis of a US national registry. Clin Transplant 2022; 36:e14588. [PMID: 35001428 DOI: 10.1111/ctr.14588] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/08/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Abstract
INTRO Textbook surgical outcome (TO) is a novel composite quality measure in lung transplantation (LTx). Compared to 1-year survival metrics, TO may better differentiate center performance, and motivate improvements in care. To understand the feasibility of implementing this metric, we defined TO in LTx using US national data, and evaluated its ability to predict post-transplant outcomes and differentiate center performance. METHODS Adult patients who underwent isolated LTx between 2016 and 2019 were included. TO was defined as freedom from post-transplant length of stay > 30 days, 90-day mortality, intubation or extracorporeal membrane oxygenation at 72 h post-transplant, post-transplant ventilator support lasting ≥5 days, postoperative airway dehiscence, inpatient dialysis, pre-discharge acute rejection, and grade 3 primary graft dysfunction at 72 h. Recipient and donor characteristics and post-transplant outcomes were compared between patients who achieved and failed TO. RESULTS Of 8959 lung transplant recipients, 4664 (52.1%) achieved TO. Patient and graft survival were improved among patients who achieved TO (both log-rank P < .0001). Among 62 centers, adjusted rates of TO ranged from 27.0% to 72.4% reflecting a wide variability in center-level performance. CONCLUSION TO defined using national data may represent a novel composite metric to guide quality improvement in LTx across US transplant centers. SUMMARY In this study we defined textbook outcome (TO) for lung transplantation (LTx) using US national data. We found that achievement of TO was associated with improved post-transplant survival, and wide variability in center-level LTx performance. These findings suggest that TO could be readily implemented to compare quality of care among US LTx centers.
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Affiliation(s)
| | - Sandra Au
- School of Medicine, Duke University, Durham, North Carolina, USA
| | | | - Danae G Olaso
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Dimitrios Moris
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Laurie D Snyder
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrew S Barbas
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - John C Haney
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jacob A Klapper
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Matthew G Hartwig
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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19
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Dal Cero M, Román M, Grande L, Yarnoz C, Estremiana F, Gantxegi A, Codony C, Gobbini Y, Garsot E, Momblan D, González-Duaigües M, Luna A, Pérez N, Aldeano A, Fernández S, Olona C, Hermoso J, Pulido L, Sánchez-Cano JJ, Güell M, Salazar D, Gimeno M, Pera M. Textbook outcome and survival after gastric cancer resection with curative intent: A population-based analysis. Eur J Surg Oncol 2021; 48:768-775. [PMID: 34753620 DOI: 10.1016/j.ejso.2021.10.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/20/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The concept of textbook outcome (TO) has been proposed for analyzing quality of surgical care. This study assessed the incidence of TO among patients undergoing curative gastric cancer resection, predictors for TO achievement, and the association of TO with survival. METHOD All patients with gastric and gastroesophageal junction cancers undergoing curative gastrectomy between January 2014-December 2017 were identified from a population-based database (Spanish EURECCA Registry). TO included: macroscopically complete resection at the time of operation, R0 resection, ≥15 lymph nodes removed and examined, no serious postoperative complications (Clavien-Dindo ≥II), no re-intervention, hospital stay ≤14 days, no 30-day readmissions and no 90-day mortality. Logistic regression was used to assess the adjusted achievement of TO. Cox survival regression was used to compare conditional adjusted survival across groups. RESULTS In total, 1293 patients were included, and TO was achieved in 541 patients (41.1%). Among the criteria, "macroscopically complete resection" had the highest compliance (96.5%) while "no serious complications" had the lowest compliance (63.7%). Age (OR 0.53 for the 65-74 years and OR 0.34 for the ≥75 years age group), Charlson comorbidity index ≥3 (OR 0.53, 95%CI 0.34-0.82), neoadjuvant chemoradiotherapy (OR 0.24, 95%CI 0.08-0.70), multivisceral resection (OR 0.55, 95%CI 0.33-0.91), and surgery performed in a community hospital (OR 0.65, CI95% 0.46-0.91) were independently associated with not achieving TO. TO was independently associated with conditional survival (HR 0.67, 95%CI 0.55-0.83). CONCLUSION TO was achieved in 41.1% of patients who underwent gastric cancer resection with curative intent and was associated with longer survival.
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Affiliation(s)
- Mariagiulia Dal Cero
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM). Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Luis Grande
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM). Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Concepción Yarnoz
- Department of Surgery, Hospital Universitario de Navarra, Pamplona, Spain
| | - Fernando Estremiana
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Amaia Gantxegi
- Department of Surgery, Hospital Vall d'Hebron, Barcelona, Spain
| | - Clara Codony
- Department of Surgery, Hospital Universitari Josep Trueta, Girona, Spain
| | - Yanina Gobbini
- Department of Surgery, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Elisenda Garsot
- Department of Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Dulce Momblan
- Department of Surgery, Hospital Clinic, Barcelona, Spain
| | | | - Alexis Luna
- Department of Surgery, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | - Noelia Pérez
- Department of Surgery, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Aurora Aldeano
- Department of Surgery, Hospital General de Granollers, Granollers, Barcelona, Spain
| | | | - Carles Olona
- Department of Surgery, Hospital Universitari de Tarragona, Joan XXIII, Tarragona, Spain
| | - Judit Hermoso
- Department of Surgery, Hospital Universitari de Vic, Vic, Barcelona, Spain
| | - Laura Pulido
- Department of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | | | - Mercè Güell
- Department of Surgery, Althaia Xarxa Assistencial i Universitária de Manresa, Manresa, Spain
| | - David Salazar
- Department of Surgery, Hospital Universitari de Igualada, Igualada, Barcelona, Spain
| | - Marta Gimeno
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM). Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Pera
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Hospital del Mar Medical Research Institute (IMIM). Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.
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