TY - JOUR
T1 - Outcomes following formation of a dedicated pediatric liver transplant anesthesia team
AU - Drobish, Julie K.
AU - Reina, Eduardo
AU - Nieva, Daniel
AU - Weinhold, Ashley
AU - George, Preeta
AU - Thompson, Douglas
AU - Khan, Adeel S.
AU - Doyle, Maria B.M.
AU - Welch, Timothy P.
N1 - Publisher Copyright:
© 2022 John Wiley & Sons Ltd.
PY - 2022/6
Y1 - 2022/6
N2 - Background: Given the complex nature of liver transplant surgery, adult centers typically use a dedicated liver transplant anesthesia team, which has improved patient outcomes. Aims: Our goal was to determine whether a dedicated pediatric liver transplant anesthesia team was associated with improved patient outcomes. Methods: This retrospective cohort study analyzed patients who underwent liver transplantation from April 2013 to September 2020 at St. Louis Children's Hospital. The general group (April 2013–December 2016) was compared with the liver group (January 2017–September 2020). Outcomes measured included cases per anesthesiologist, early extubation, ventilator days, fluid and blood administration, postoperative events, and intensive care unit and hospital length of stay (LOS). Results: Patients in both groups had similar demographics. The average number of cases/anesthesiologist/year was 2.9 times higher in the liver group (mean (SD) general 0.7 (0.5), liver 2.0 (0.6), and difference in mean [95% CI] 1.3 [0.8, 1.8]). The rate of extubation in the operating room was higher for patients in the liver group (general 56%, liver 80%, and difference in proportion [95% CI] 24.7 [7.0, 42.4]), while the number of ventilator days was lower (mean (SD) general 2.1 (4.4), liver 1.1 (3.6), and difference in proportion [95%CI] −0.9 [−2.6, 0.7]). Colloid administration was higher in the liver group (mean (SD) general 23.9 (14.5) ml/kg, liver 48.4 (37.7) ml/kg, and difference in mean [95% CI] 24.6 [12.7, 36.4]), while fresh frozen plasma administration was lower in the liver group (mean (SD) general 15.3 (23.9) ml/kg, liver 6.2 (14) ml/kg, and difference in mean [95% CI] −9.0 [−16.8, −1.3]). There were no significant differences between the groups in postoperative events including blood product transfusions, vasopressor use, and thromboses, or in the intensive care unit and hospital LOS. Conclusions: The liver group was associated with increased early extubations, decreased ventilator days, and decreased fresh frozen plasma use.
AB - Background: Given the complex nature of liver transplant surgery, adult centers typically use a dedicated liver transplant anesthesia team, which has improved patient outcomes. Aims: Our goal was to determine whether a dedicated pediatric liver transplant anesthesia team was associated with improved patient outcomes. Methods: This retrospective cohort study analyzed patients who underwent liver transplantation from April 2013 to September 2020 at St. Louis Children's Hospital. The general group (April 2013–December 2016) was compared with the liver group (January 2017–September 2020). Outcomes measured included cases per anesthesiologist, early extubation, ventilator days, fluid and blood administration, postoperative events, and intensive care unit and hospital length of stay (LOS). Results: Patients in both groups had similar demographics. The average number of cases/anesthesiologist/year was 2.9 times higher in the liver group (mean (SD) general 0.7 (0.5), liver 2.0 (0.6), and difference in mean [95% CI] 1.3 [0.8, 1.8]). The rate of extubation in the operating room was higher for patients in the liver group (general 56%, liver 80%, and difference in proportion [95% CI] 24.7 [7.0, 42.4]), while the number of ventilator days was lower (mean (SD) general 2.1 (4.4), liver 1.1 (3.6), and difference in proportion [95%CI] −0.9 [−2.6, 0.7]). Colloid administration was higher in the liver group (mean (SD) general 23.9 (14.5) ml/kg, liver 48.4 (37.7) ml/kg, and difference in mean [95% CI] 24.6 [12.7, 36.4]), while fresh frozen plasma administration was lower in the liver group (mean (SD) general 15.3 (23.9) ml/kg, liver 6.2 (14) ml/kg, and difference in mean [95% CI] −9.0 [−16.8, −1.3]). There were no significant differences between the groups in postoperative events including blood product transfusions, vasopressor use, and thromboses, or in the intensive care unit and hospital LOS. Conclusions: The liver group was associated with increased early extubations, decreased ventilator days, and decreased fresh frozen plasma use.
KW - blood transfusion
KW - dedicated team
KW - early extubation
KW - immediate extubation
KW - length of stay
KW - pediatric liver transplantation
KW - postoperative outcomes
UR - http://www.scopus.com/inward/record.url?scp=85125441342&partnerID=8YFLogxK
U2 - 10.1111/pan.14421
DO - 10.1111/pan.14421
M3 - Article
C2 - 35174581
AN - SCOPUS:85125441342
SN - 1155-5645
VL - 32
SP - 732
EP - 739
JO - Paediatric Anaesthesia
JF - Paediatric Anaesthesia
IS - 6
ER -