Skip to main content

Advertisement

SpringerLink
Log in

Textbook Outcomes in Liver Transplantation

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Textbook outcome (TO) is an emerging concept within multiple surgical domains, which represents a novel effort to define a standardized, composite quality benchmark based on multiple postoperative endpoints that represent the ideal “textbook” hospitalization. We sought to define TO for liver transplantation (LT) using a cohort from a high procedural volume center.

Methods

Patients who underwent LT at our institution between 2014 and 2017 were eligible for the study. The definition of TO was determined by clinician consensus at our institution to include freedom from: mortality within 90 days, primary allograft non-function, early allograft dysfunction (EAD), rejection within 30 days, readmission with 30 days, readmission to the ICU during index hospitalization, hospital length of stay > 75th percentile of all liver transplant patients, red blood cell (RBC) transfusion requirement greater than the 75th percentile for all liver transplant patients, Clavien–Dindo Grade III complication (re-intervention), and major intraoperative complication.

Results

Two hundred and thirty-one liver transplants with complete data were performed within the study period. Of those, 71 (31%) achieved a TO. Overall, the most likely event to lead to failure to achieve TO was readmission within 30 days (n = 57, 37%) or reoperation (n = 49, 32%). Overall and rejection-free survival did not differ significantly between the 2 groups. Interestingly, patients who achieved TO incurred approximately $60,000 less in total charges than those who did not. When we limit this to charges specifically attributable to the transplant episode, the difference was approximately $50,000 and remained significantly less for those that achieved TO.

Conclusions

Here, we present the first definition of TO in LT. Though not associated with long-term outcomes, TO in LT is associated with a significantly lower charges and costs of the initial hospitalization. A multi-institutional study to validate this definition of TO is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Starzl TE et al (1963) Homotransplantation of the liver in humans. Surg Gynecol Obstet 117:659–676

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Adam R et al (2012) Evolution of indications and results of liver transplantation in europe. a report from the european liver transplant registry (ELTR). J Hepatol 57(3):675–688

    Article  Google Scholar 

  3. Agopian VG et al (2013) The evolution of liver transplantation during 3 decades: analysis of 5347 consecutive liver transplants at a single center. Ann Surg 258(3):409–421

    Article  Google Scholar 

  4. Kim WR et al (2017) OPTN/SRTR 2015 annual data report: liver. Am J Transplant 17(Suppl 1):174–251

    Article  Google Scholar 

  5. Moris D et al (2017) Liver transplantation for unresectable colorectal liver metastases: a systematic review. J Surg Oncol 116(3):288–297

    Article  Google Scholar 

  6. Moris D et al (2017) Liver transplantation in patients with liver metastases from neuroendocrine tumors: a systematic review. Surgery 162(3):525–536

    Article  Google Scholar 

  7. Moris D et al (2019) Comparison between liver transplantation and resection for hilar cholangiocarcinoma: a systematic review and meta-analysis. PLoS ONE 14(7):e0220527

    Article  CAS  Google Scholar 

  8. Dutkowski P et al (2015) Challenges to liver transplantation and strategies to improve outcomes. Gastroenterology 148(2):307–323

    Article  Google Scholar 

  9. Gao Q et al (2019) Improvement in liver transplant outcomes from older donors: a US national analysis. Ann Surg 270(2):333–339

    Article  Google Scholar 

  10. Taylor R et al (2019) Survival advantage for patients accepting the offer of a circulatory death liver transplant. J Hepatol 70(5):855–865

    Article  Google Scholar 

  11. Muller X et al (2018) Defining benchmarks in liver transplantation: a multicenter outcome analysis determining best achievable results. Ann Surg 267(3):419–425

    Article  Google Scholar 

  12. Kolfschoten NE et al (2013) Focusing on desired outcomes of care after colon cancer resections; hospital variations in 'textbook outcome'. Eur J Surg Oncol 39(2):156–163

    Article  CAS  Google Scholar 

  13. Busweiler LA et al (2017) Textbook outcome as a composite measure in oesophagogastric cancer surgery. Br J Surg 104(6):742–750

    Article  CAS  Google Scholar 

  14. Merath K et al (2019) A multi-institutional international analysis of textbook outcomes among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. JAMA Surg 154:e190571

    Article  Google Scholar 

  15. van Roessel S et al (2020) Textbook outcome: nationwide analysis of a novel quality measure in pancreatic surgery. Ann Surg 271(1):155–162

    Article  Google Scholar 

  16. Merath K et al (2020) Textbook outcomes among medicare patients undergoing hepatopancreatic surgery. Ann Surg 271:1116–1123

    Article  Google Scholar 

  17. Priego P et al (2019) Comparison of laparoscopic versus open gastrectomy for treatment of gastric cancer: analysis of a textbook outcome. J Laparoendosc Adv Surg Tech A 29(4):458–464

    Article  Google Scholar 

  18. Karthaus EG et al (2017) Textbook outcome: a composite measure for quality of elective aneurysm surgery. Ann Surg 266(5):898–904

    Article  Google Scholar 

  19. Poelemeijer YQM et al (2019) Textbook outcome: an ordered composite measure for quality of bariatric surgery. Obes Surg 29(4):1287–1294

    Article  Google Scholar 

  20. Levy J et al (2020) Gastrectomy case volume and textbook outcome: an analysis of the population registry of esophageal and stomach tumours of ontario (PRESTO). Gastric Cancer 23:391–402

    Article  Google Scholar 

  21. Olthoff KM et al (2010) Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl 16(8):943–949

    Article  Google Scholar 

  22. Lee DD et al (2016) Early allograft dysfunction after liver transplantation: an intermediate outcome measure for targeted improvements. Ann Hepatol 15(1):53–60

    Article  Google Scholar 

  23. Dijs-Elsinga J et al (2010) Choosing a hospital for surgery: the importance of information on quality of care. Med Decis Making 30(5):544–555

    Article  Google Scholar 

  24. Tsilimigras, DI, et al. (2020) Assessing textbook outcomes following liver surgery for primary liver cancer over a 12-year time period at major hepatobiliary centers. Ann Surg Oncol

  25. Dimick JB et al (2009) Composite measures for predicting surgical mortality in the hospital. Health Aff (Millwood) 28(4):1189–1198

    Article  Google Scholar 

  26. Dimick JB, Welch HG, Birkmeyer JD (2004) Surgical mortality as an indicator of hospital quality: the problem with small sample size. JAMA 292(7):847–851

    Article  CAS  Google Scholar 

  27. Dimick JB et al (2012) Composite measures for rating hospital quality with major surgery. Health Serv Res 47(5):1861–1879

    Article  Google Scholar 

  28. van der Kaaij RT et al (2018) Using textbook outcome as a measure of quality of care in oesophagogastric cancer surgery. Br J Surg 105(5):561–569

    Article  Google Scholar 

  29. Merath K et al (2019) a multi-institutional international analysis of textbook outcomes among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. JAMA Surg 154(6):e190571

    Article  Google Scholar 

  30. Levy J, et al. (2020) Textbook outcome and survival in patients with gastric cancer: an analysis of the population registry of esophageal and stomach tumours in ontario (PRESTO). Ann Surg

  31. Moris D et al (2020) Textbook outcomes among patients undergoing retroperitoneal sarcoma resection. Anticancer Res 40(4):2107–2115

    Article  Google Scholar 

  32. Tsilimigras DI, et al. (2019) Hospital variation in textbook outcomes following curative-intent resection of hepatocellular carcinoma: an international multi-institutional analysis. HPB (Oxford)

  33. Cramm SL et al (2016) Failure to rescue as a quality improvement approach in transplantation: a first effort to evaluate this tool in pediatric liver transplantation. Transplantation 100(4):801–807

    Article  CAS  Google Scholar 

  34. Sweigert PJ et al (2020) Assessment of textbook oncologic outcomes following pancreaticoduodenectomy for pancreatic adenocarcinoma. J Surg Oncol 121(6):936–944

    Article  Google Scholar 

  35. Salet N et al (2018) Is textbook outcome a valuable composite measure for short-term outcomes of gastrointestinal treatments in the netherlands using hospital information system data? a retrospective cohort study. BMJ Open 8(2):e019405

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, Box 3512, Durham, NC, 27710, USA

    Dimitrios Moris, Brian I. Shaw, Jared Gloria, Samuel J. Kesseli, Mariya L. Samoylova, Robin Schmitz, Miriam Manook, Lisa M. McElroy, Stuart J. Knechtle, Debra L. Sudan & Andrew S. Barbas

  2. Department of Medicine, Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA

    Yuval Patel & Carl L. Berg

Authors
  1. Dimitrios Moris
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian I. Shaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jared Gloria
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Samuel J. Kesseli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mariya L. Samoylova
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robin Schmitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Miriam Manook
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lisa M. McElroy
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yuval Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Carl L. Berg
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Stuart J. Knechtle
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Debra L. Sudan
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Andrew S. Barbas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew S. Barbas.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moris, D., Shaw, B.I., Gloria, J. et al. Textbook Outcomes in Liver Transplantation. World J Surg 44, 3470–3477 (2020). https://doi.org/10.1007/s00268-020-05625-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-020-05625-9

Search

Navigation