Statistical Quality Control Charts for Liver Transplant Process Indicators: Evaluation of a Single-Center Experience

• Published in: Transplantation proceedings 2012-07, Vol.44 (6), p.1517-1522
• Main Authors: Varona, M.A, Soriano, A, Aguirre-Jaime, A, Barrera, M.A, Medina, M.L, Bañon, N, Mendez, S, Lopez, E, Portero, J, Dominguez, D, Gonzalez, A
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Survival; Guideline Adherence; Humans; Liver Transplantation - adverse effects; Liver Transplantation - mortality; Liver Transplantation - standards; Liver Transplantation - statistics & numerical data; Medical sciences; Outcome and Process Assessment (Health Care) - standards; Outcome and Process Assessment (Health Care) - statistics & numerical data; Patient Satisfaction; Postoperative Complications - etiology; Postoperative Complications - surgery; Practice Guidelines as Topic; Program Evaluation; Quality Improvement - standards; Quality Improvement - statistics & numerical data; Quality Indicators, Health Care - standards; Quality Indicators, Health Care - statistics & numerical data; Reoperation; Retrospective Studies; Spain; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tissue, organ and graft immunology; Treatment Outcome; Waiting Lists
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2012.05.009

Abstract Liver transplantation, the best option for many end-stage liver diseases, is indicated in more candidates than the donor availability. In this situation, this demanding treatment must achieve excellence, accessibility and patient satisfaction to be ethical, scientific, and efficient. The current consensus of quality measurements promoted by the Sociedad Española de Trasplante Hepático (SETH) seeks to depict criteria, indicators, and standards for liver transplantation in Spain. According to this recommendation, the Canary Islands liver program has studied its experience. We separated the 411 cadaveric transplants performed in the last 15 years into 2 groups: The first 100 and the other 311. The 8 criteria of SETH 2010 were correctly fulfilled. In most indicators, the outcomes were favorable, with an actuarial survivals at 1, 3, 5, and 10 years of 84%, 79%, 76%, and 65%, respectively; excellent results in retransplant rates (early 0.56% and long-term 5.9%), primary nonfunction rate (0.43%), waiting list mortality (13.34%), and patient satisfaction (91.5%). On the other hand, some indicators of mortality were worse as perioperative, postoperative, and early mortality with normal graft function and reoperation rate. After the analyses of the series with statistical quality control charts, we observed an improvement in all indicators, even in the apparently worst, early mortality with normal graft functions in a stable program. Such results helped us to discover specific areas to improve the program. The application of the quality measurement, as SETH consensus recommends, has shown in our study that despite being a consuming time process, it is a useful tool.