Opportunities for Salvage for Optimizing Ideal Outcomes
In order to optimize outcomes following pediatric liver transplantation, clinicians must take a dual approach: (1) to prevent complications and (2) to successfully salvage patients after complications occur. In this chapter, the latter is addressed through understanding the utility of “failure to rescue” in perioperative quality improvement and specific strategies to address the most common complications in this population. Failure to rescue, a measure of a center’s ability to recognize quickly and effectively manage complications, is defined as mortality following a severe complication, and there is an increasing evidence to suggest its importance in efforts to improve outcomes following major surgery. The core tenets of successful rescue include early diagnosis and effective rescue. Hospital-level factors including team structure and communication and access to resources such as intensive care units and emergency operating rooms are essential to the ability to salvage a patient following complications. Strategies to enhance these aspects are discussed for common and morbid complications following this operation, including vascular complications, biliary tract complications, graft failure, and sepsis. By addressing the period after a complication occurs, clinicians can address disparities in the ability to rescue pediatric liver transplant patients and intervene on a period critical to optimizing outcomes.
KeywordsPediatric liver transplantation Graft loss Mortality Complications Failure to rescue Salvage
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