title: The effect of gained experience on postoperative complications and mortality in cadaveric liver transplantation: a single-center experience.
abstract: OBJECTIVE
  Liver transplantation (OLT) has become the treatment of choice for end-stage liver failure, as well as for selected cases of malignancies and metabolic disorders. Decreased postoperative complications and mortality rates are expected to correlate with improvements in the interdisciplinary team approach, the perioperative anesthesiologic and intensive care management, and careful follow-up after transplantation. In this study, we have evaluated the effect of gained experience on postoperative complications and mortality in cadaveric OLT performed in our institution.
  
  
  METHODS
  Data from cadaveric OLT patients (n = 34) since 2003 were retrospectively evaluated. Patients were divided into 2 groups: Early (2003-2006; n = 15) and late (2007-2010; n = 19). Age, gender, cold and warm ischemia times, intraoperative transfusion rates, infectious complications, biliary and vascular complication rates, and early and late postoperative mortality rates were compared in the 2 groups.
  
  
  RESULTS
  The age and gender distribution was similar among both groups. Mean cold and warm ischemia times, intraoperative transfusion rates, and operative times were significantly lower in the late period group (P = .004, .012, and 0.008, respectively; CI=%95). T-tube usage was also significantly lower in the late period group (P < .001). There was no significant change for postoperative intensive care period (P = .404), but the overall length of stay in hospital was shorter for the patients in the late period group (P = .019). The nonsurgical early postoperative complication rate was lower (P = .001) and early postoperative mortality was nearly significant (P = .06) in patients who comprised the late period group. There was no difference in terms of biliary and vascular complication rates and overall survival rates between patients in the early and late groups (P = .664, .264, and .107, respectively).
  
  
  CONCLUSIONS
  Our results indicate that the institutional improvements toward an interdisciplinary team approach in cadaveric OLT correlate with better results in ischemia and operative times and lower intraoperative transfusion rates and hospital stays. Early postoperative complication and mortality rates were found to decline in parallel to the team experience.
authors.affiliation: Gülhane Military Medical Academy, Department of Surgery, Ankara, Turkey. gyagci@gata.edu.tr
authors.forename: G
authors.initials: G
authors.lastname: Yağci
authors.forename: S
authors.initials: S
authors.lastname: Cetiner
authors.forename: N
authors.initials: N
authors.lastname: Ersöz
authors.forename: I
authors.initials: I
authors.lastname: Hakki Özerhan
authors.forename: M F
authors.initials: MF
authors.lastname: Can
authors.forename: F
authors.initials: F
authors.lastname: Bilgin
authors.forename: A
authors.initials: A
authors.lastname: Coşar
authors.forename: S
authors.initials: S
authors.lastname: Bağci
authors.forename: B
authors.initials: B
authors.lastname: Ustünsöz
authors.forename: Y
authors.initials: Y
authors.lastname: Karslioğlu
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies