Cold Ischemia Time, Surgeon, Time of Day, and Surgical Complications

Seow, Ying-Ying; Alkari, Bassam; Dyer, Phil; Riad, Hany

doi:10.1097/01.tp.0000122230.46091.e2

Cited by 51 publications

(47 citation statements)

References 9 publications

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“…Die Er fah rung des Ope ra teurs als we sent li ches Kri te rium wird auch in ei ner Ar beit aus Man ches ter deut lich [15]. Bei An we sen heit ei nes Con sul tants wäh rend der Trans plan ta tion fiel die Kom pli ka ti ons ra te sig ni fi kant nied ri ger aus.…”

Section: Dis Kus Si Onunclassified

Urologische Komplikationen nach Nierentransplantation

Burmeister

Noster

Kram

et al. 2006

Urologe

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Between August 1981 and May 2005, 1065 consecutive kidney transplants were performed at our center; 393 patients (36.9%) developed urological complications in the first 60 postoperative days. Urinary tract infections occurred in 28.5% of all patients. The major urological problems seen were urinary leakage and ureteral obstruction in 6.2% and 1.4% of the patients. Two grafts were lost due to severe urinary leakage. No patient death occurred due to urological complications. The incidence of urological complications is mainly influenced by the surgical procedure of organ retrieval and ureteroneocystostomy. With double-J stenting of the extravesical ureteroneocystostomy, we observed a significantly lower rate of urinary leakage but a higher rate of urinary tract infections in our series. Early diagnosis and treatment of urological complications may prevent further morbidity of our transplant patients.

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Section: Dis Kus Si Onunclassified

Urologische Komplikationen nach Nierentransplantation

Burmeister

Noster

Kram

et al. 2006

Urologe

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“…At least some centers have adopted this strategy in light of single center data suggesting worse outcomes are associated with nighttime recipient operations (13,14). For liver transplantation, however, the adverse impact of prolonging cold ischemia is well established, and the window of acceptable CIT is decidedly narrower, to the extent that delaying a recipient operation in favor of a daytime operation could render some grafts unusable (15 Lonze et al …”

Section: The Field Of Transplantation Is Unique Among the Surgical Sumentioning

confidence: 99%

Operative Start Times and Complications After Liver Transplantation

Lonze

Parsikia²,

Feyssa

et al. 2010

American Journal of Transplantation

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The recent national focus on patient safety has led to a re-examination of the risks and benefits of nighttime surgery. In liver transplantation, the hypothetical risks of nighttime operation must be weighed against either the well-established risks of prolonging cold ischemia or the potential risks of strategies to manipulate operative start times. A retrospective review was conducted of 578 liver transplants performed at a single institution between 1995 and 2008 to determine whether the incidence of postoperative complications correlated with operative start times. We hypothesized that no correlation would be observed between complication rates and operative start times. No consistent trends in relative risk of postoperative wound, vascular, biliary, or other complications were observed when eight 3-h time strata were compared. When two 12-h time strata (night, 3 p.m.-3 a.m., and day, 3 a.m.-3 p.m.) were compared, complications were not significantly different, but nighttime operations were longer in duration, and were associated a twofold greater risk of early death compared to daytime operations (adjusted OR 2.9, 95% CI 1.16-7.00, p = 0.023), though long-term survival did not differ significantly between the subgroups. This observation warrants further evaluation and underscores the need to explore and identify institution-specific practices that ensure safe operations regardless of time of day.

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“…4 The importance of This has been the aim in our centre for the last 5 years. Our findings in this study suggest that we have succeeded in our aim.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…The majority of operations performed within normal working hours as well as outof-hours involved trainee surgeons; indeed, two-thirds were performed in the absence of a consultant. 4 Implementing the EWTD will certainly have a major impact on the current practice of renal transplantation in the UK. Our study looked to see if, through the years, our centre has been successful at reducing CIT and, particularly, whether the attempts to reduce CIT has impacted on the pattern of operating times and the amount of out-of-hours operations performed.…”

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confidence: 99%

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Impact of Changing Trend in Cold Ischaemic Time on Operating Times in Renal Transplantation

Seow

Riad

Dyer

2006

annals

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Ann R Coll Surg Engl 2006; 88: 667-671 667Renal transplantation in our centre, and in most of the UK, is carried out on the emergency theatre list, competing for priority amongst other urgent, non-scheduled surgical procedures. This together with the 'randomness' in availability of donors has resulted in transplant surgery being known as an 'out-of-hours' specialty.It is well-established that a short cold ischaemia time (CIT) is an important factor for both the short-term but, more importantly, the long-term outcome of renal allograft function and survival. 1,2 Attempting to achieve shorter CIT has, therefore, become an important aim for our unit. In this study, we tried to establish how successful we have been in achieving this over the last 11 years bearing in mind the constraints of limited facilities. During this period, our centre provided renal transplantation services to the whole of the north-west region of England, covering patients from four adult dialysis centres and an adult population of 4.5 million. On average, 110 cadaveric, adult, renal-only transplants and 55 organ retrievals were carried out in a year.The other prompt for our study was the European Working Time Directive (EWTD). In 1998, the UK Government decided to implement the EWTD as health and safety legislation law. Amongst medical practitioners, the original legislation applied to consultants only. This has, however, extended to trainees. The aim is to reduce the working hours of doctors in training gradually, eventually to 48 h/week, including on-call, by the year 2009. 3 We showed in a previous study that just over half of the renal transplants in our centre between 1998 and 2001 were performed outside normal working hours. The majority of operations performed within normal working hours as well as outof-hours involved trainee surgeons; indeed, two-thirds were performed in the absence of a consultant. 4 Implementing the EWTD will certainly have a major impact on the current practice of renal transplantation in the UK. Renal transplantation is well-recognised as an out-of-hours specialty. Our study looks at whether our renal transplant centre's attempt to reduce cold ischaemic time (CIT) has impacted on the pattern of operating times since this may have implications on the surgeons' working hours.

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Cold Ischemia Time, Surgeon, Time of Day, and Surgical Complications

Abstract: Prolonged CIT and operating out of normal working hours did not increase the incidence of surgical complications. Presence of a consultant did, however, reduce the likelihood of a surgical complication occurring.

Cited by 51 publications

References 9 publications

Urologische Komplikationen nach Nierentransplantation

Urologische Komplikationen nach Nierentransplantation

Operative Start Times and Complications After Liver Transplantation

Impact of Changing Trend in Cold Ischaemic Time on Operating Times in Renal Transplantation

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