Medizinische Universität Graz - Research portal
Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Schrem, H; Volz, S; Koch, HF; Gwiasda, J; Kürsch, P; Goldis, A; Pöhnert, D; Winny, M; Klempnauer, J; Kaltenborn, A.
Statistical approach to quality assessment in liver transplantation.
Langenbecks Arch Surg. 2018; 403(1): 61-71.
Doi: 10.1007/s00423-017-1612-7
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- Leading authors Med Uni Graz
- Schrem Harald Heinrich
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- Abstract:
- This study investigated the utility of retrospective two one-sided cumulative sum (CUSUM) charts combined with multivariable regression analysis in liver transplantation for transplant center benchmarking. One thousand seven hundred and forty-nine consecutive adult primary liver transplants (January 1, 1983 to December 31, 2012) were analyzed retrospectively with two one-sided CUSUM chart analysis of 90-day mortality. Three eras and two subseries in latest era 3 were identified due to graphically delineated relevant shifts in mean 90-day mortality. Delineation of eras 1, 2, and 3 coincided with relevant changes in allocation policies. CUSUM analysis detected a resurgence of higher mean 90-day mortality in era 3 after results had improved continuously over 25 years. In era 3, two subseries were identified with improving mean 90-day mortality rates from 15.4% in subseries 1 to 8.9% in the following subseries 2. The quantitative influence of independent risk factors on 90-day mortality differed markedly between all identified eras and subseries as assessed with multivariable regression analysis deployed on era-specific subcohorts. The assessed methodology is able to identify meaningful center-specific eras and subseries of liver transplantation with striking alterations of the significance and weight of outcome drivers for post-transplant 90-day mortality over time. This warrants the introduction of prospective risk-adjusted two one-sided CUSUM chart analysis into quality management in liver transplantation in Germany with the goal to obtain alarm signals as early as possible.
- Find related publications in this database (using NLM MeSH Indexing)
- Adult -
- Female -
- Humans -
- Liver Diseases - mortality
- Liver Diseases - pathology
- Liver Diseases - surgery
- Liver Transplantation -
- Male -
- Middle Aged -
- Multivariate Analysis -
- Quality Assurance, Health Care -
- Regression Analysis -
- Retrospective Studies -
- Risk Assessment -
- Survival Rate -
- Find related publications in this database (Keywords)
- Mortality
- Risk-adjusted analysis
- Multivariable regression
- Risk factors for survival
- Purposeful variable selection