Renal transplantation: relationship between hospital/surgeon volume and postoperative severe sepsis/graft-failure. a nationwide population-based study.
UNLABELLED
BACKGROUND AND OBJECTS: We explored the relationship between hospital/surgeon volume and postoperative severe sepsis/graft-failure (including death).


METHODS
The Taiwan National Health Insurance Research Database claims data for all patients with end-stage renal disease patients who underwent kidney transplantation between January 1, 1999, and December 31, 2007, were reviewed. Surgeons and hospitals were categorized into two groups based on their patient volume. The two primary outcomes were severe sepsis and graft failure (including death). The logistical regressions were done to compute the Odds ratios (OR) of outcomes after adjusting for possible confounding factors. Kaplan-Meier analysis was used to calculate the cumulative survival rates of graft failure after kidney transplantation during follow-up (1999-2008).


RESULTS
The risk of developing severe sepsis in a hospital in which surgeons do little renal transplantation was significant (odds ratio [OR]; p = 0.0115): 1.65 times (95% CI: 1.12-2.42) higher than for a hospital in which surgeons do many. The same trend was true for hospitals with a low volume of renal transplantations (OR = 2.39; 95% CI: 1.62-3.52; p < 0.0001). The likelihood of a graft failure (including death) within one year for the low-volume surgeon group was 3.1 times higher than for the high-volume surgeon group (p < 0.0001); the trend was similar for hospital volume. Female patients had a lower risk than did male patients, and patients ≥ 55 years old and those with a higher Charlson comorbidity index score, had a higher risk of severe sepsis.


CONCLUSIONS
We conclude that the risk of severe sepsis and graft failure (including death) is higher for patients treated in hospitals and by surgeons with a low volume of renal transplantations. Therefore, the health authorities should consider exporting best practices through educational outreach and regulation and then providing transparent information for public best interest.
['Weng|Shih-Feng|SF|', 'Chu|Chin-Chen|CC|', 'Chien|Chih-Chiang|CC|', 'Wang|Jhi-Joung|JJ|', 'Chen|Yi-Chen|YC|', 'Chiou|Shang-Jyh|SJ|']
D000328:Adult D016208:Databases, Factual D005260:Female D006084:Graft Rejection D006761:Hospitals D006801:Humans D053208:Kaplan-Meier Estimate D007676:Kidney Failure, Chronic D016030:Kidney Transplantation D016015:Logistic Models D008297:Male D008875:Middle Aged D011183:Postoperative Complications D018805:Sepsis D066231:Surgeons D013624:Taiwan D000078329:Workforce
renal transplantation sepsis population-based graft failure volume-outcome relationship.