International Journal of Medical Sciences

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23 October 2017

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Int J Med Sci 2014; 11(9):918-924. doi:10.7150/ijms.8850

Research Paper

Renal Transplantation: Relationship between Hospital/Surgeon Volume and Postoperative Severe Sepsis/Graft-Failure. A Nationwide Population-Based Study

Shih-Feng Weng1,4*, Chin-Chen Chu2*, Chih-Chiang Chien3,5, Jhi-Joung Wang1, Yi-Chen Chen1, Shang-Jyh Chiou6✉

1. Departments of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
2. Departments of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan.
3. Departments of Nephrology, Chi-Mei Medical Center, Tainan, Taiwan.
4. Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
5. Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan.
6. Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taiwan.
* These authors made equal contributions to this paper.

Abstract

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.

Keywords: graft failure, population-based, renal transplantation, sepsis, volume-outcome relationship.

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) License. See http://ivyspring.com/terms for full terms and conditions.
How to cite this article:
Weng SF, Chu CC, Chien CC, Wang JJ, Chen YC, Chiou SJ. Renal Transplantation: Relationship between Hospital/Surgeon Volume and Postoperative Severe Sepsis/Graft-Failure. A Nationwide Population-Based Study. Int J Med Sci 2014; 11(9):918-924. doi:10.7150/ijms.8850. Available from http://www.medsci.org/v11p0918.htm