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Textbook Outcome: Definition and Analysis of a Novel Quality Measure in Lung Transplantation.

Publication ,  Journal Article
Halpern, SE; Moris, D; Gloria, JN; Shaw, BI; Haney, JC; Klapper, JA; Barbas, AS; Hartwig, MG
Published in: Ann Surg
February 1, 2023

OBJECTIVE: To define textbook outcome (TO) for lung transplantation (LTx) using a contemporary cohort from a high-volume institution. SUMMARY BACKGROUND DATA: TO is a standardized, composite quality measure based on multiple postoperative endpoints representing the ideal "textbook" hospitalization. METHODS: Adult patients who underwent LTx at our institution between 2016 and 2019 were included. TO was defined as freedom from intraoperative complication, postoperative reintervention, 30-day intensive care unit or hospital readmission, length of stay >75th percentile of LTx patients, 90 day mortality, 30-day acute rejection, grade 3 primary graft dysfunction at 48 or 72 hours, postoperative extracorporeal membrane oxygenation, tracheostomy within 7 days, inpatient dialysis, reintubation, and extubation >48 hours post-transplant. Recipient, operative, financial characteristics, and post-transplant outcomes were recorded from institutional data and compared between TO and non-TO groups. RESULTS: Of 401 LTx recipients, 97 (24.2%) achieved TO. The most common reason for TO failure was extubation >48 hours post-transplant (N = 119, 39.1%); the least common was mortality (N = 15, 4.9%). Patient and graft survival were improved among patients who achieved versus failed TO (patient survival: log-rank P < 0.01; graft survival: log-rank P < 0.01). Rejection-free and chronic lung allograft dysfunction-free survival were similar between TO and non-TO groups (rejection-free survival: log-rank P = 0.07; chronic lung allograft dysfunction-free survival: log-rank P = 0.3). On average, patients who achieved TO incurred approximately $638,000 less in total inpatient charges compared to those who failed TO. CONCLUSIONS: TO in LTx was associated with favorable post-transplant outcomes and significant cost-savings. TO may offer providers and patients new insight into transplant center quality of care and highlight areas for improvement.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

February 1, 2023

Volume

277

Issue

2

Start / End Page

350 / 357

Location

United States

Related Subject Headings

  • Transplantation, Homologous
  • Surgery
  • Retrospective Studies
  • Quality Indicators, Health Care
  • Lung Transplantation
  • Lung
  • Humans
  • Adult
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences
 

Citation

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Halpern, S. E., Moris, D., Gloria, J. N., Shaw, B. I., Haney, J. C., Klapper, J. A., … Hartwig, M. G. (2023). Textbook Outcome: Definition and Analysis of a Novel Quality Measure in Lung Transplantation. Ann Surg, 277(2), 350–357. https://doi.org/10.1097/SLA.0000000000004916
Halpern, Samantha E., Dimitrios Moris, Jared N. Gloria, Brian I. Shaw, John C. Haney, Jacob A. Klapper, Andrew S. Barbas, and Matthew G. Hartwig. “Textbook Outcome: Definition and Analysis of a Novel Quality Measure in Lung Transplantation.Ann Surg 277, no. 2 (February 1, 2023): 350–57. https://doi.org/10.1097/SLA.0000000000004916.
Halpern SE, Moris D, Gloria JN, Shaw BI, Haney JC, Klapper JA, et al. Textbook Outcome: Definition and Analysis of a Novel Quality Measure in Lung Transplantation. Ann Surg. 2023 Feb 1;277(2):350–7.
Halpern, Samantha E., et al. “Textbook Outcome: Definition and Analysis of a Novel Quality Measure in Lung Transplantation.Ann Surg, vol. 277, no. 2, Feb. 2023, pp. 350–57. Pubmed, doi:10.1097/SLA.0000000000004916.
Halpern SE, Moris D, Gloria JN, Shaw BI, Haney JC, Klapper JA, Barbas AS, Hartwig MG. Textbook Outcome: Definition and Analysis of a Novel Quality Measure in Lung Transplantation. Ann Surg. 2023 Feb 1;277(2):350–357.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

February 1, 2023

Volume

277

Issue

2

Start / End Page

350 / 357

Location

United States

Related Subject Headings

  • Transplantation, Homologous
  • Surgery
  • Retrospective Studies
  • Quality Indicators, Health Care
  • Lung Transplantation
  • Lung
  • Humans
  • Adult
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences