Definition and Analysis of Textbook Outcome: A Novel Quality Measure in Kidney Transplantation.

Journal Article (Journal Article)

BACKGROUND: "Textbook outcome" (TO) is a novel composite quality measure that encompasses multiple postoperative endpoints, representing the ideal "textbook" hospitalization for complex surgical procedures. We defined TO for kidney transplantation using a cohort from a high-volume institution. METHODS: Adult patients who underwent isolated kidney transplantation at our institution between 2016 and 2019 were included. TO was defined by clinician consensus at our institution to include freedom from intraoperative complication, postoperative reintervention, 30-day intensive care unit or hospital readmission, length of stay > 75th percentile of kidney transplant patients, 90-day mortality, 30-day acute rejection, delayed graft function, and discharge with a Foley catheter. Recipient, operative, financial characteristics, and post-transplant patient, graft, and rejection-free survival were compared between patients who achieved and failed to achieve TO. RESULTS: A total of 557 kidney transplant patients were included. Of those, 245 (44%) achieved TO. The most common reasons for TO failure were delayed graft function (N = 157, 50%) and hospital readmission within 30 days (N = 155, 50%); the least common was mortality within 90 days (N = 6, 2%). Patient, graft, and rejection-free survival were significantly improved among patients who achieved TO. On average, patients who achieved TO incurred approximately $50,000 less in total inpatient charges compared to those who failed TO. CONCLUSIONS: TO in kidney transplantation was associated with favorable post-transplant outcomes and significant cost-savings. TO may offer transplant centers a detailed performance breakdown to identify aspects of perioperative care in need of process improvement.

Full Text

Duke Authors

Cited Authors

  • Halpern, SE; Moris, D; Shaw, BI; Kesseli, SJ; Samoylova, ML; Manook, M; Schmitz, R; Collins, BH; Sanoff, SL; Ravindra, KV; Sudan, DL; Knechtle, SJ; Ellis, MJ; McElroy, LM; Barbas, AS

Published Date

  • May 1, 2021

Published In

Volume / Issue

  • 45 / 5

Start / End Page

  • 1504 - 1513

PubMed ID

  • 33486584

Pubmed Central ID

  • PMC8281331

Electronic International Standard Serial Number (EISSN)

  • 1432-2323

Digital Object Identifier (DOI)

  • 10.1007/s00268-020-05943-y


  • eng

Conference Location

  • United States