Quality of pancreatic transplant program assessment using a risk-adjusted cumulative sum chart: experience from a single, small center.
BACKGROUND
The high rate of complication after pancreas transplantation not only had an impact on recipient quality of life and survival but also had significant financial implications. Thus, monitoring transplant center performance was crucial to indentifying changes in clinical practice that result in quality deterioration.


OBJECTIVE
To evaluate retrospectively the quality of the single, small pancreatic transplant program and to establish prospective monitoring of the center using risk-adjusted cumulative sum (CUSUM).


METHODS
From 1988 to 2014, 119 simultaneous pancreas and the kidney transplantations (SPKTx) were performed. The program was divided into 3 eras, based on surgical technique and immunosuppression. Analyses of the 15 fatal outcomes due to complication from pancreatic graft were performed. The risk model was developed using multivariable logistic regression analysis based on retrospective data of 112 SPKTx recipients. The risk-adjusted 1-sided CUSUM chart was plotted for retrospective and prospective events. The upper control limit was set to 2.


RESULTS
There were 2 main causes of death: multiorgan failure (73.3%; 11/15) and septic hemorrhage (26.7%; 4/15). Quality analysis using the CUSUM chart revealed that the process was not homogeneous; however, no significant signal of program deterioration was obtained and the performance of the whole program was within the settled control limit.


CONCLUSIONS
For a single pancreatic transplant center. The risk-adjusted CUSUM chart was a useful tool for quality program assessment. It could support decision making during traditional surgical morbidity and mortality conferences. For small transplant centers, increasing the sensitivity of the CUSUM method by lowering the upper control limit should be considered. However, an individual assessment approach of the for particular centers is recommended.
Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Poland. Electronic address: tadeusz.grochowiecki@wum.edu.pl.
T
T
Grochowiecki
Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Poland.
T
T
Jakimowicz
2nd Department of Clinical Radiology, Medical University of Warsaw, Poland.
L
L
Grabowska-Derlatka
Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Poland.
J
J
Szmidt
D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*; D012189:Retrospective Studies; D012306:Risk; D020379:Risk Adjustment
D007166:Immunosuppressive Agents