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    Please use this identifier to cite or link to this item: http://ir.cnu.edu.tw/handle/310902800/28671


    標題: Renal Transplantation: Relationship between Hospital/Surgeon Volume and Postoperative Severe Sepsis/Graft-Failure. A Nationwide Population-Based Study
    作者: Weng, Shih-Feng
    Chu, Chin-Chen
    Chien, Chih-Chiang
    Wang, Jhi-Joung
    Chen, Yi-Chen
    Chiou, Shang-Jyh
    貢獻者: 醫務管理系
    關鍵字: graft failure
    population-based
    renal transplantation
    sepsis
    volume-outcome relationship
    日期: 2014
    上傳時間: 2015-05-06 21:24:37 (UTC+8)
    出版者: Ivyspring Int Publ
    摘要: Background and objects: We explored the relationship between hospital/surgeon volume and postoperative severe sepsis/graft-failure (including death). Methods: The Taiwan National Health Insurance Research Database claims data for all patients with end-stage renal disease patients who underwent kidney transplantation between January 1, 1999, and December 31, 2007, were reviewed. Surgeons and hospitals were categorized into two groups based on their patient volume. The two primary outcomes were severe sepsis and graft failure (including death). The logistical regressions were done to compute the Odds ratios (OR) of outcomes after adjusting for possible confounding factors. Kaplan-Meier analysis was used to calculate the cumulative survival rates of graft failure after kidney transplantation during follow-up (1999-2008). Results: The risk of developing severe sepsis in a hospital in which surgeons do little renal transplantation was significant (odds ratio [OR]; p = 0.0115): 1.65 times (95% CI: 1.12-2.42) higher than for a hospital in which surgeons do many. The same trend was true for hospitals with a low volume of renal transplantations (OR = 2.39; 95% CI: 1.62-3.52; p < 0.0001). The likelihood of a graft failure (including death) within one year for the low-volume surgeon group was 3.1 times higher than for the high-volume surgeon group (p < 0.0001); the trend was similar for hospital volume. Female patients had a lower risk than did male patients, and patients = 55 years old and those with a higher Charlson comorbidity index score, had a higher risk of severe sepsis. Conclusions: We conclude that the risk of severe sepsis and graft failure (including death) is higher for patients treated in hospitals and by surgeons with a low volume of renal transplantations. Therefore, the health authorities should consider exporting best practices through educational outreach and regulation and then providing transparent information for public best interest.
    關聯: International Journal of Medical Sciences, v.11 n.9, pp.918-924
    Appears in Collections:[醫務管理系(所)] 期刊論文

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