Operative mortality after renal transplantation - Does surgeon type matter?
Operative mortality after renal transplantation - Does surgeon type matter?
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DOI：
10.1016/j.juro.2007.02.006
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发表时间：
2007-06-01
影响因子：
6.6
通讯作者：
Krein, Sarah L.
中科院分区：
文献类型：
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作者：
Hollingsworth, John M.;Hollenbeck, Brent K.;Krein, Sarah L.
目的：目前在加拿大和美国有64个认可的肾移植奖学金。只有27%的手术仅限于肾脏移植。在剩下的实习项目中，受训者学习移植多个腹部器官。考虑到多器官移植外科医生的发展，我们评估了当前的培训模式对肾移植的实践模式和结果的影响。材料与方法：采用1993 ~ 2003年全国住院患者样本，抽取6674例肾移植出院记录。通过全国住院患者样本唯一外科医生标识符，我们确定了多器官和仅肾移植外科医生进行肾移植的比例。我们拟合多水平回归模型来检验外科医生类型和移植结果之间的关系。结果：我们确定了99名多器官移植外科医生和196名仅肾移植外科医生，他们分别进行了3255例和3419例肾移植手术。单肾移植外科医生比多器官外科医生更有可能在非教学、私立、营利性医院执业（p < 0.05）。接受肾脏移植手术的患者与接受多器官移植手术的患者相比，未经调整的手术死亡率更高（1.7% vs 0.9%, p = 0.002）。在对患者和医院因素进行调整后，接受多器官移植手术的患者住院死亡的几率比仅接受肾脏移植手术的患者低55% （OR 0.45, 95% CI 0.26-0.76）。结论：尽管目前的培训模式，肾脏移植外科医生在肾移植中发挥着突出的作用。然而，鉴于目前供体器官的短缺和对质量的影响，观察到的死亡率差异表明，需要进一步的调查来确定是否应该减少这一作用。
Purpose: 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.Materials and 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.