title: Operative mortality after renal transplantation--does surgeon type matter?
abstract: OBJECTIVE
  Currently there are 64 accredited renal transplantation fellowships in Canada and the United States. Only 27% are limited in scope to kidney transplants. In the remaining fellowships the trainee learns to transplant multiple abdominal organs. Given this evolution to the multiorgan transplant surgeon, we evaluated the effect of the current training paradigm on practice patterns and outcomes for kidney transplants.
  
  
  METHODS
  Using data from the Nationwide Inpatient Sample, discharge records for kidney transplants (6,674) were abstracted (1993 to 2003). Through the Nationwide Inpatient Sample unique surgeon identifier we determined the proportion of kidney transplants performed by multiorgan and kidney only transplant surgeons. We fit multilevel regression models to examine the relationship between surgeon type and transplant outcome.
  
  
  RESULTS
  We identified 99 multiorgan and 196 kidney only transplant surgeons who performed 3,255 and 3,419 kidney transplants, respectively. Kidney only transplant surgeons were more likely than multiorgan surgeons to practice in nonteaching, private, for-profit hospitals (p <0.05). Unadjusted operative mortality was higher in patients treated by kidney only vs multiorgan transplant surgeons (1.7% vs 0.9%, p = 0.002). After adjusting for patient and hospital factors, those who underwent renal transplantation performed by multiorgan transplant surgeons had 55% lower odds of inpatient death (OR 0.45, 95% CI 0.26-0.76) vs kidney only transplant surgeons.
  
  
  CONCLUSIONS
  Despite the current training paradigm, kidney only transplant surgeons have a prominent role in renal transplantation. However, given the current donor organ shortage and the implications for quality, the observed mortality difference suggests that additional investigation is needed to determine whether this role should be decreased.
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Hollingsworth
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Englesbe
authors.forename: Sonya
authors.initials: S
authors.lastname: DeMonner
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Krein
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010819:Physician's Role; D012189:Retrospective Studies; D013043:Specialties, Surgical; D014481:United States / Q000453:epidemiology