Impact of Anesthesiologist Experience on Early Outcomes in Adult Orthotopic Liver Transplantation
Liver transplantation is a complex surgical procedure. The experience of the anesthesiologist, and its potential relationship to patient morbidity and mortality, is yet to be determined. We sought to explore this possible association using our institutional training patterns as the subject of study....
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| Published in: | Transplantation proceedings Vol. 53; no. 5; pp. 1665 - 1669 |
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| Main Authors: | , , , , , , , |
| Format: | Journal Article |
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01-06-2021
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| Abstract | Liver transplantation is a complex surgical procedure. The experience of the anesthesiologist, and its potential relationship to patient morbidity and mortality, is yet to be determined. We sought to explore this possible association using our institutional training patterns as the subject of study.
This is a single center retrospective analysis investigating the association of an anesthesiologist's experience with liver transplantation and its potential effect on early patient outcomes in adult liver transplant recipients from January 2010 to September 2016. Training of team members consisted of a 6-month period of clinical shadowing with a senior anesthesiologist and co-staffing 8 liver transplant procedures before solo staffing a liver transplant. Specifically, patient outcomes for the first 5 transplants after this training were investigated.
The only independent risk factor for early death or early graft loss was the amount of packed red blood cells administered during transplantation. With respect to secondary outcomes, the amount of packed red blood cells and hospitalization at the time of transplant were associated with the number of days on a ventilator, length of intensive care unit stay, and overall hospital length of stay.
The results of this study conclude that the training model currently in place for our new team members has no negative impact on patient outcomes after liver transplantation. |
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| AbstractList | BACKGROUNDLiver transplantation is a complex surgical procedure. The experience of the anesthesiologist, and its potential relationship to patient morbidity and mortality, is yet to be determined. We sought to explore this possible association using our institutional training patterns as the subject of study. METHODSThis is a single center retrospective analysis investigating the association of an anesthesiologist's experience with liver transplantation and its potential effect on early patient outcomes in adult liver transplant recipients from January 2010 to September 2016. Training of team members consisted of a 6-month period of clinical shadowing with a senior anesthesiologist and co-staffing 8 liver transplant procedures before solo staffing a liver transplant. Specifically, patient outcomes for the first 5 transplants after this training were investigated. RESULTSThe only independent risk factor for early death or early graft loss was the amount of packed red blood cells administered during transplantation. With respect to secondary outcomes, the amount of packed red blood cells and hospitalization at the time of transplant were associated with the number of days on a ventilator, length of intensive care unit stay, and overall hospital length of stay. CONCLUSIONSThe results of this study conclude that the training model currently in place for our new team members has no negative impact on patient outcomes after liver transplantation. Liver transplantation is a complex surgical procedure. The experience of the anesthesiologist, and its potential relationship to patient morbidity and mortality, is yet to be determined. We sought to explore this possible association using our institutional training patterns as the subject of study. This is a single center retrospective analysis investigating the association of an anesthesiologist's experience with liver transplantation and its potential effect on early patient outcomes in adult liver transplant recipients from January 2010 to September 2016. Training of team members consisted of a 6-month period of clinical shadowing with a senior anesthesiologist and co-staffing 8 liver transplant procedures before solo staffing a liver transplant. Specifically, patient outcomes for the first 5 transplants after this training were investigated. The only independent risk factor for early death or early graft loss was the amount of packed red blood cells administered during transplantation. With respect to secondary outcomes, the amount of packed red blood cells and hospitalization at the time of transplant were associated with the number of days on a ventilator, length of intensive care unit stay, and overall hospital length of stay. The results of this study conclude that the training model currently in place for our new team members has no negative impact on patient outcomes after liver transplantation. |
| Author | Hebbar, Latha Fleming, James N. Colhoun, Edward D. Mester, Robert A. Stoll, William D. Abro, Joseph A. Sirianni, Joel M. Taber, David J. |
| Author_xml | – sequence: 1 givenname: William D. surname: Stoll fullname: Stoll, William D. email: stollwil@musc.edu organization: Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina – sequence: 2 givenname: Robert A. surname: Mester fullname: Mester, Robert A. organization: Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina – sequence: 3 givenname: James N. surname: Fleming fullname: Fleming, James N. organization: Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina – sequence: 4 givenname: Joel M. surname: Sirianni fullname: Sirianni, Joel M. organization: Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina – sequence: 5 givenname: Joseph A. surname: Abro fullname: Abro, Joseph A. organization: Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina – sequence: 6 givenname: Edward D. surname: Colhoun fullname: Colhoun, Edward D. organization: Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina – sequence: 7 givenname: David J. surname: Taber fullname: Taber, David J. organization: Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, South Carolina – sequence: 8 givenname: Latha surname: Hebbar fullname: Hebbar, Latha organization: Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina |
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| Cites_doi | 10.1056/NEJMsa035205 10.1097/ALN.0000000000002534 10.1053/j.jvca.2013.07.004 10.1002/lt.24014 10.1016/j.jss.2008.10.015 10.1097/00000542-198502000-00002 10.1177/1089253217737043 10.1002/lt.21719 10.1213/ANE.0000000000001781 10.1056/NEJMsa1010705 10.1016/j.jss.2015.08.010 |
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| References_xml | – volume: 130 start-page: 237 year: 2019 end-page: 246 ident: bib0007 article-title: Anesthesiologist specialization and use of general anesthesia for cesarean delivery publication-title: Anesthesiology contributor: fullname: Neuman – volume: 200 start-page: 427 year: 2016 end-page: 434 ident: bib0010 article-title: Effect of surgeon and anesthesiologist volume on surgical outcomes publication-title: J Surg Res contributor: fullname: Makary – volume: 158 start-page: 20 year: 2010 end-page: 27 ident: bib0013 article-title: Risk of adverse outcomes associated with blood transfusion after cardiac surgery depends on the amount of transfusion publication-title: J Surg Res contributor: fullname: Shumway – volume: 349 start-page: 2117 year: 2003 end-page: 2127 ident: bib0001 article-title: Surgeon volume and operative mortality in the United States publication-title: N Engl J Med contributor: fullname: Lucas – volume: 125 start-page: 147 year: 2017 end-page: 155 ident: bib0006 article-title: Association between anesthesiology volumes and early and late outcomes after cystectomy for bladder cancer: a population-based study publication-title: Anesth Analg contributor: fullname: Booth – volume: 21 start-page: 89 year: 2015 end-page: 95 ident: bib0004 article-title: Association between anesthesiologist experience and mortality after orthotopic liver transplantation publication-title: Liver Transpl contributor: fullname: Yaport – volume: 15 start-page: 307 year: 2017 end-page: 317 ident: bib0014 article-title: Red blood cell transfusion policy: a critical literature review publication-title: Blood Transfus contributor: fullname: Carlo – volume: 62 start-page: 107 year: 1985 end-page: 114 ident: bib0003 article-title: Does perioperative myocardial ischaemia lead to postoperative myocardial infarction? 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publication-title: Anesthesiology doi: 10.1097/00000542-198502000-00002 contributor: fullname: Slogoff – volume: 21 start-page: 352 year: 2017 ident: 10.1016/j.transproceed.2021.04.004_bib0005 article-title: Society for the Advancement of Transplant Anesthesia: liver transplant anesthesia fellowship-white paper advocating measurable proficiency in transplant specialties training publication-title: Semin Cardiothorac Vasc Anesth doi: 10.1177/1089253217737043 contributor: fullname: Chadha – volume: 15 start-page: 460 year: 2009 ident: 10.1016/j.transproceed.2021.04.004_bib0012 article-title: Designated liver transplant anesthesia team reduces blood transfusion, need for mechanical ventilation, and duration of intensive care publication-title: Liver Transpl doi: 10.1002/lt.21719 contributor: fullname: Hevesi – volume: 15 start-page: 307 year: 2017 ident: 10.1016/j.transproceed.2021.04.004_bib0014 article-title: Red blood cell transfusion policy: a critical literature review publication-title: Blood Transfus contributor: fullname: Massimo – volume: 125 start-page: 147 year: 2017 ident: 10.1016/j.transproceed.2021.04.004_bib0006 article-title: Association between anesthesiology volumes and early and late outcomes after cystectomy for bladder cancer: a population-based study publication-title: Anesth Analg doi: 10.1213/ANE.0000000000001781 contributor: fullname: Jaeger – ident: 10.1016/j.transproceed.2021.04.004_bib0011 – volume: 364 start-page: 2128 year: 2011 ident: 10.1016/j.transproceed.2021.04.004_bib0002 article-title: Trends in hospital volume and operative mortality for high-risk surgery publication-title: N Engl J Med doi: 10.1056/NEJMsa1010705 contributor: fullname: Finks – volume: 200 start-page: 427 year: 2016 ident: 10.1016/j.transproceed.2021.04.004_bib0010 article-title: Effect of surgeon and anesthesiologist volume on surgical outcomes publication-title: J Surg Res doi: 10.1016/j.jss.2015.08.010 contributor: fullname: Gani |
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| Title | Impact of Anesthesiologist Experience on Early Outcomes in Adult Orthotopic Liver Transplantation |
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