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Influence of broader geographic allograft sharing on outcomes and cost in smaller lung transplant centers
OBJECTIVE: On November 24, 2017, Organ Procurement and Transplantation Network implemented a change to lung allocation replacing donor service area with a 250 nautical mile radius around donor hospitals. We sought to evaluate the experience of a small to medium size center following implementation....
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
by The American Association for Thoracic Surgery
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7474916/ https://www.ncbi.nlm.nih.gov/pubmed/33008575 http://dx.doi.org/10.1016/j.jtcvs.2020.09.008 |
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author | Haywood, Nathan Mehaffey, J. Hunter Kilbourne, Sarah Mannem, Hannah Weder, Max Lau, Christine Krupnick, Alexander S. Agarwal, Avinash |
author_facet | Haywood, Nathan Mehaffey, J. Hunter Kilbourne, Sarah Mannem, Hannah Weder, Max Lau, Christine Krupnick, Alexander S. Agarwal, Avinash |
author_sort | Haywood, Nathan |
collection | PubMed |
description | OBJECTIVE: On November 24, 2017, Organ Procurement and Transplantation Network implemented a change to lung allocation replacing donor service area with a 250 nautical mile radius around donor hospitals. We sought to evaluate the experience of a small to medium size center following implementation. METHODS: Patients (47 pre and 54 post) undergoing lung transplantation were identified from institutional database from January 2016 to October 2019. Detailed chart review and analysis of institutional cost data was performed. Univariate analysis was performed to compare eras. RESULTS: Similar short-term mortality and primary graft dysfunction were observed between groups. Decreased local donation (68% vs 6%; P < .001), increased travel distance (145 vs 235 miles; P = .004), travel cost ($8626 vs $14,482; P < .001), and total procurement cost ($60,852 vs $69,052; P = .001) were observed postimplementation. We also document an increase in waitlist mortality postimplementation (6.9 vs 31.6 per 100 patient-years; P < .001). CONCLUSIONS: Following implementation of the new allocation policy in a small to medium size center, several changes were in accordance with policy intention. However, concerning shifts emerged, including increased waitlist mortality and resource utilization. Continued close monitoring of transplant centers stratified by size and location are paramount to maintaining global availability of lung transplantation to all Americans regardless of geographic residence or socioeconomic status. |
format | Online Article Text |
id | pubmed-7474916 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | by The American Association for Thoracic Surgery |
record_format | MEDLINE/PubMed |
spelling | pubmed-74749162020-09-08 Influence of broader geographic allograft sharing on outcomes and cost in smaller lung transplant centers Haywood, Nathan Mehaffey, J. Hunter Kilbourne, Sarah Mannem, Hannah Weder, Max Lau, Christine Krupnick, Alexander S. Agarwal, Avinash J Thorac Cardiovasc Surg Transplantation OBJECTIVE: On November 24, 2017, Organ Procurement and Transplantation Network implemented a change to lung allocation replacing donor service area with a 250 nautical mile radius around donor hospitals. We sought to evaluate the experience of a small to medium size center following implementation. METHODS: Patients (47 pre and 54 post) undergoing lung transplantation were identified from institutional database from January 2016 to October 2019. Detailed chart review and analysis of institutional cost data was performed. Univariate analysis was performed to compare eras. RESULTS: Similar short-term mortality and primary graft dysfunction were observed between groups. Decreased local donation (68% vs 6%; P < .001), increased travel distance (145 vs 235 miles; P = .004), travel cost ($8626 vs $14,482; P < .001), and total procurement cost ($60,852 vs $69,052; P = .001) were observed postimplementation. We also document an increase in waitlist mortality postimplementation (6.9 vs 31.6 per 100 patient-years; P < .001). CONCLUSIONS: Following implementation of the new allocation policy in a small to medium size center, several changes were in accordance with policy intention. However, concerning shifts emerged, including increased waitlist mortality and resource utilization. Continued close monitoring of transplant centers stratified by size and location are paramount to maintaining global availability of lung transplantation to all Americans regardless of geographic residence or socioeconomic status. by The American Association for Thoracic Surgery 2020-09-06 /pmc/articles/PMC7474916/ /pubmed/33008575 http://dx.doi.org/10.1016/j.jtcvs.2020.09.008 Text en © 2020 by The American Association for Thoracic Surgery. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Transplantation Haywood, Nathan Mehaffey, J. Hunter Kilbourne, Sarah Mannem, Hannah Weder, Max Lau, Christine Krupnick, Alexander S. Agarwal, Avinash Influence of broader geographic allograft sharing on outcomes and cost in smaller lung transplant centers |
title | Influence of broader geographic allograft sharing on outcomes and cost in smaller lung transplant centers |
title_full | Influence of broader geographic allograft sharing on outcomes and cost in smaller lung transplant centers |
title_fullStr | Influence of broader geographic allograft sharing on outcomes and cost in smaller lung transplant centers |
title_full_unstemmed | Influence of broader geographic allograft sharing on outcomes and cost in smaller lung transplant centers |
title_short | Influence of broader geographic allograft sharing on outcomes and cost in smaller lung transplant centers |
title_sort | influence of broader geographic allograft sharing on outcomes and cost in smaller lung transplant centers |
topic | Transplantation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7474916/ https://www.ncbi.nlm.nih.gov/pubmed/33008575 http://dx.doi.org/10.1016/j.jtcvs.2020.09.008 |
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