Comprehensive quality initiative leads to immediate postoperative extubation following liver transplant
Authors' conclusion
A structured QI initiative led to sustained high rates of IPE and reduced LOS in all liver transplant recipients, including those classified as high risk.
Study context
- Population
- Liver transplant recipients after primary (PAC) or delayed abdominal closure (DAC), single academic institution, 2013–2018
- Participants
- 591 recipients
- Exposure
- Immediate postoperative extubation (IPE) vs delayed extubation (DE)
- Outcome
- Incidence of IPE
Methodological detailssingle-centre, quality improvement initiative
- Single-centre
- Quality improvement initiative
Main finding
As reported in the abstract
Incidence of IPE, 2013 vs 2018
IPE after PAC, 2013
9 of 67
13.4%
IPE after PAC, 2018
78 of 90
86.7%
IPE after DAC, 2013
1 of 12
8.3%
IPE after DAC, 2018
16 of 23
69.6%
Observational data: associations, not effects.
Further findings
| Outcome | HR of discharge (95% CI) | P value | |
|---|---|---|---|
| ICU LOS | 1.92 (1.58–2.33) | P < 0.001 | |
| Hospital LOS | 1.45 (1.20–1.76) | P < 0.001 | |
| 0.512HR of discharge (log scale) |
IPE after PAC in high-risk subgroups (subgroup), 2013 vs 2018
- MELD ≥30: 2013 vs 2018
- 0/19 (0%) to 12/17 (70.6%)
- Simultaneous liver-kidney transplant: 2013 vs 2018
- 1/8 (12.5%) to 4/5 (80.0%)
- Massive transfusion (>10 units RBC): 2013 vs 2018
- 0/17 (0%) to 10/13 (76.9%)
Mortality
- IPE not associated with mortality
Safety
Reintubation for respiratory considerations <48 h after IPE
- After PAC
- 3/278 (1.1%)
- After DAC
- 1/39 (2.6%)
Original publication
Comprehensive quality initiative leads to immediate postoperative extubation following liver transplant. J Clin Anesth. Published 20 December 2022. doi:10.
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