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Statistical approach to quality assessment in liver transplantation

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Abstract

Purpose

This study investigated the utility of retrospective two one-sided cumulative sum (CUSUM) charts combined with multivariable regression analysis in liver transplantation for transplant center benchmarking.

Methods

One thousand seven hundred and forty-nine consecutive adult primary liver transplants (January 1, 1983 to December 31, 2012) were analyzed retrospectively with two one-sided CUSUM chart analysis of 90-day mortality.

Results

Three eras and two subseries in latest era 3 were identified due to graphically delineated relevant shifts in mean 90-day mortality. Delineation of eras 1, 2, and 3 coincided with relevant changes in allocation policies. CUSUM analysis detected a resurgence of higher mean 90-day mortality in era 3 after results had improved continuously over 25 years. In era 3, two subseries were identified with improving mean 90-day mortality rates from 15.4% in subseries 1 to 8.9% in the following subseries 2. The quantitative influence of independent risk factors on 90-day mortality differed markedly between all identified eras and subseries as assessed with multivariable regression analysis deployed on era-specific subcohorts.

Conclusion

The assessed methodology is able to identify meaningful center-specific eras and subseries of liver transplantation with striking alterations of the significance and weight of outcome drivers for post-transplant 90-day mortality over time. This warrants the introduction of prospective risk-adjusted two one-sided CUSUM chart analysis into quality management in liver transplantation in Germany with the goal to obtain alarm signals as early as possible.

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Author information

Author notes

  1. Harald Schrem and Sophia Volz contributed equally to this paper.

Authors and Affiliations

  1. Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany

    Harald Schrem, Sophia Volz, Hans-Friedrich Koch, Jill Gwiasda, Priscila Kürsch, Alon Goldis & Alexander Kaltenborn

  2. Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany

    Harald Schrem, Daniel Pöhnert, Markus Winny & Jürgen Klempnauer

  3. Department of Trauma and Orthopedic Surgery, Federal Armed Forces Hospital, Westerstede, Germany

    Alexander Kaltenborn

Authors
  1. Harald Schrem
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  2. Sophia Volz
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  3. Hans-Friedrich Koch
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  4. Jill Gwiasda
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  5. Priscila Kürsch
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  6. Alon Goldis
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  7. Daniel Pöhnert
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  8. Markus Winny
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  9. Jürgen Klempnauer
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  10. Alexander Kaltenborn
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Contributions

Study conception and design: Harald Schrem, Sophia Volz, Hans-Friedrich Koch, Priscila Kürsch, and Alexander Kaltenborn. Acquisition of data: Harald Schrem, Sophia Volz, Priscila Kürsch, and Alexander Kaltenborn. Analysis and interpretation of data: Harald Schrem, Sophia Volz, Hans-Friedrich Koch, Jill Gwiasda, Priscila Kürsch, Alon Goldis, Jürgen Klempnauer, and Alexander Kaltenborn. Drafting of manuscript: Harald Schrem, Sophia Volz, Jill Gwiasda, and Alexander Kaltenborn. Critical revision of manuscript: Harald Schrem, Sophia Volz, Jill Gwiasda, Hans-Friedrich Koch, Priscila Kürsch, Alon Goldis, Daniel Pöhnert, Markus Winny, Jürgen Klempnauer, and Alexander Kaltenborn.

Corresponding author

Correspondence to Alexander Kaltenborn.

Ethics declarations

Funding

This study was funded by a grant from the German Federal Ministry of Education and Research (reference number: 01EO1302).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with animal or human participants performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Schrem, H., Volz, S., Koch, HF. et al. Statistical approach to quality assessment in liver transplantation. Langenbecks Arch Surg 403, 61–71 (2018). https://doi.org/10.1007/s00423-017-1612-7

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  • DOI: https://doi.org/10.1007/s00423-017-1612-7

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