In:
Journal of Cardiothoracic Surgery, Springer Science and Business Media LLC, Vol. 17, No. 1 ( 2022-09-01)
Abstract:
For complex surgical procedures a volume-outcome relationship can often be demonstrated implicating multiple factors at a unit and surgeon specific level. This study aims to investigate this phenomenon in lung transplantation over a 30-year period with particular reference to surgeon age and experience, cumulative unit activity and time/day of transplant. Methods Prospective databases identified adult patients undergoing isolated lung transplantation at a single UK centre between June 1987 and October 2017. Mortality data was acquired from NHS Spine. Individual surgeon demographics were obtained from the General Medical Council. Student t -test, Pearson’s Chi-squared, Logistic Regression, and Kaplan–Meier Survival analyses were performed using Analyse-it package for MicrosoftExcel and STATA/IC. Results 954 transplants (55.9% male, age 44.4 ± 13.8 years, 67.9% bilateral lung) were performed, with a median survival to follow-up of 4.37 years. There was no difference in survival by recipient gender ( p = 0.661), between individual surgeons ( p = 0.224), or between weekday/weekend procedures ( p = 0.327). Increasing centre experience with lung transplantation (OR1.001, 95%CI: 1.000–1.001, p = 0.03) and successive calendar years (OR1.028, 95%CI: 1.005–1.052, p = 0.017) was associated with improved 5-year survival. Advancing surgeon age at the time of transplant (mean, 48.8 ± 6.6 years) was associated with improved 30-day survival (OR1.062, 95%CI: 1.019 to1.106, p = 0.003), which persisted 5 years post-transplant (OR1.043, 95%CI: 1.014–1.073, p = 0.003). Individual surgeon experience, measured by the number of previous lung transplants performed, showed a trend towards improved outcomes at 30 days ( p = 0.0413) with no difference in 5-year survival ( p = 0.192). Conclusions Our study demonstrates a relationship between unit volume, increasing surgeon age and survival after lung transplantation. A transplant volume: outcome relationship was not seen for individual surgeons.
Type of Medium:
Online Resource
ISSN:
1749-8090
DOI:
10.1186/s13019-022-01943-2
Language:
English
Publisher:
Springer Science and Business Media LLC
Publication Date:
2022
detail.hit.zdb_id:
2227224-0
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