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Textbook surgical outcome in lung transplantation: Analysis of a US national registry.

Textbook surgical outcome (TO) is a novel composite quality measure in lung transplantation (LTx). Compared to one-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. Adult patients who underwent isolated LTx between 2016-2019 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 hours 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 hours. Recipient and donor characteristics and post-transplant outcomes were compared between patients who achieved and failed TO. 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<0.0001). Among 62 centers, adjusted rates of TO ranged from 27.0% to 72.4% reflecting a wide variability in center-level performance. 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. This article is protected by copyright. All rights reserved.

Citation: 

Krischak, Madison K., Sandra Au, Samantha E. Halpern, Danae G. Olaso, Dimitrios Moris, Laurie D. Snyder, Andrew S. Barbas, John C. Haney, Jacob A. Klapper, and Matthew G. Hartwig. “Textbook surgical outcome in lung transplantation: Analysis of a US national registry.” Clinical Transplantation, January 9, 2022, e14588. https://doi.org/10.1111/ctr.14588.

Published Date: 
Sunday, January 9, 2022
Published In: 
Clinical Transplantation
PMID: 
35001428