The concept of a composite perioperative quality index in kidney transplantation.
BACKGROUND
Public reporting of patient and graft outcomes in a national registry and close Centers for Medicare and Medicaid Services oversight has resulted in transplantation being a highly regulated surgical discipline. Despite this, transplantation surgery lacks comprehensive tracking and reporting of perioperative quality measures. Therefore, the aim of this study was to determine the association between a kidney transplantation centers' perioperative quality benchmarking and graft and patient outcomes.


METHODS
This was an analysis of 2011 aggregate data compiled from 2 national datasets that track outcomes from member hospitals and transplantation centers. The transplantation centers included in this study were composed of accredited US kidney transplantation centers that report data through the national registry and are associate members of the University HealthSystem Consortium.


RESULTS
A total of 16,811 kidney transplantations were performed at 236 centers in the United States in 2011, of which 10,241 (61%) from 93 centers were included in the analysis. Of the 6 perioperative quality indicators, 3 benchmarked metrics were significantly associated with a kidney transplantation center's underperformance: mean ICU length of stay (C-statistic 0.731; p = 0.002), 30-day readmissions (C-statistic 0.697; p = 0.012) and in-hospital complications (C-statistic 0.785; p = 0.001). The composite quality index strongly correlated with inadequate center performance (C-statistic 0.854; p < 0.001, R(2) = 0.349). The centers in the lowest quartile of the quality index performed 2,400 kidney transplantations in 2011, which led to 2,640 more hospital days, 4,560 more ICU days, 120 more postoperative complications, and 144 more patients with 30-day readmissions, when compared with centers in the 3 higher-quality quartiles.


CONCLUSIONS
An objective index of a transplantation center's quality of perioperative care is significantly associated with patient and graft survival.
Medical University of South Carolina, Division of Transplant Surgery, Charleston, SC. Electronic address: taberd@musc.edu.
David J
DJ
Taber
Medical University of South Carolina, Division of Transplant Surgery, Charleston, SC.
John W
JW
McGillicuddy
Medical University of South Carolina, Division of Transplant Surgery, Charleston, SC.
Charles F
CF
Bratton
Medical University of South Carolina, Division of Transplant Surgery, Charleston, SC.
Angello
A
Lin
Medical University of South Carolina, Division of Transplant Surgery, Charleston, SC.
Kenneth D
KD
Chavin
Medical University of South Carolina, Division of Transplant Surgery, Charleston, SC.
Prabhakar K
PK
Baliga
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality / Q000592:standards*; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012372:ROC Curve; D012042:Registries; D014481:United States; D055815:Young Adult