title: Anesthesia for liver transplantation in US academic centers: institutional structure and perioperative care.
abstract: Investigators at a single institution have shown that the organization of the anesthesia team influences patient outcomes after liver transplant surgery. Little is known about how liver transplant anesthesiologists are organized to deliver care throughout the United States. Therefore, we collected quantitative survey data from adult liver transplant programs in good standing with national governing agencies so that we could describe team structure and duties. Information was collected from 2 surveys in a series of quantitative surveys conducted by the Liver Transplant Anesthesia Consortium. All data related to duties, criteria for team membership, interactions/communication with the multidisciplinary team, and service availability were collected and summarized. Thirty-four of 119 registered transplant centers were excluded (21 pediatric centers and 13 centers not certified by national governing agencies). Private practice sites (26) were later excluded because of a poor response rate. There were minimal changes in the compositions of the programs between the 2 surveys. All academic programs had distinct liver transplant anesthesia teams. Most had set criteria for membership and protocols outlining the preoperative evaluation, attended selection committees, and were always available for transplant surgery. Fewer were involved in postoperative care or were available for patients needing subsequent surgery. Most trends were associated with the center volume. In conclusion, some of the variance in team structure and responsibilities is probably related to resources available at the site of practice. However, similarities in specific duties across all teams suggest some degree of self-initiated specialization.
authors.affiliation: Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA. ann.walia@vanderbilt.edu
authors.forename: Ann
authors.initials: A
authors.lastname: Walia
authors.forename: M Susan
authors.initials: MS
authors.lastname: Mandell
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Mercaldo
authors.forename: Damon
authors.initials: D
authors.lastname: Michaels
authors.forename: Amy
authors.initials: A
authors.lastname: Robertson
authors.forename: Arna
authors.initials: A
authors.lastname: Banerjee
authors.forename: Ramachander
authors.initials: R
authors.lastname: Pai
authors.forename: John
authors.initials: J
authors.lastname: Klinck
authors.forename: Matthew
authors.initials: M
authors.lastname: Weinger
authors.forename: Pratik
authors.initials: P
authors.lastname: Pandharipande
authors.forename: Roman
authors.initials: R
authors.lastname: Schumann
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000328:Adult; D000768:Anesthesia, General / Q000706:statistics & numerical data*; D000776:Anesthesiology / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D000078329:Workforce