Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss
Background. This retrospective cohort study evaluates the advantages of risk balancing between prolonged cold ischemic time (CIT) and late night surgery. Methods. 1262 deceased donor kidney transplantations were analyzed. Multivariable regression was used to determine odds ratios (ORs) for reoperati...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Journal of Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2017/5362704 |
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| author | Nikos Emmanouilidis Julius Boeckler Bastian P. Ringe Alexander Kaltenborn Frank Lehner Hans Friedrich Koch Jürgen Klempnauer Harald Schrem |
| author_facet | Nikos Emmanouilidis Julius Boeckler Bastian P. Ringe Alexander Kaltenborn Frank Lehner Hans Friedrich Koch Jürgen Klempnauer Harald Schrem |
| author_sort | Nikos Emmanouilidis |
| collection | DOAJ |
| description | Background. This retrospective cohort study evaluates the advantages of risk balancing between prolonged cold ischemic time (CIT) and late night surgery. Methods. 1262 deceased donor kidney transplantations were analyzed. Multivariable regression was used to determine odds ratios (ORs) for reoperation, graft loss, delayed graft function (DGF), and discharge on dialysis. CIT was categorized according to a forward stepwise pattern ≤1h/>1h, ≤2h/>2h, ≤3h/>3h,…, ≤nh/>nh. ORs for DGF were plotted against CIT and a nonlinear regression function with best R2 was identified. First and second derivative were then implemented into the curvature formula k(x)=f′′(x)/(1+f′x2)3/2 to determine the point of highest CIT-mediated risk acceleration. Results. Surgery between 3 AM and 6 AM is an independent risk factor for reoperation and graft loss, whereas prolonged CIT is only relevant for DGF. CIT-mediated risk for DGF follows an exponential pattern fx=A·(1+k·eI·x) with a cut-off for the highest risk increment at 23.5 hours. Conclusions. The risk of surgery at 3 AM–6 AM outweighs prolonged CIT when confined within 23.5 hours as determined by a new mathematical approach to calculate turning points of nonlinear time related risks. CIT is only relevant for the endpoint of DGF but had no impact on discharge on dialysis, reoperation, or graft loss. |
| format | Article |
| id | doaj-art-2c1f37dd4e754714ab4e2feeade782e4 |
| institution | Kabale University |
| issn | 2090-0007 2090-0015 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Transplantation |
| spelling | doaj-art-2c1f37dd4e754714ab4e2feeade782e42025-02-03T01:21:51ZengWileyJournal of Transplantation2090-00072090-00152017-01-01201710.1155/2017/53627045362704Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft LossNikos Emmanouilidis0Julius Boeckler1Bastian P. Ringe2Alexander Kaltenborn3Frank Lehner4Hans Friedrich Koch5Jürgen Klempnauer6Harald Schrem7General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, GermanyGeneral, Visceral and Transplant Surgery, Hannover Medical School, Hannover, GermanyGeneral, Visceral and Transplant Surgery, Hannover Medical School, Hannover, GermanyCore Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, GermanyGeneral, Visceral and Transplant Surgery, Hannover Medical School, Hannover, GermanyCore Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, GermanyGeneral, Visceral and Transplant Surgery, Hannover Medical School, Hannover, GermanyGeneral, Visceral and Transplant Surgery, Hannover Medical School, Hannover, GermanyBackground. This retrospective cohort study evaluates the advantages of risk balancing between prolonged cold ischemic time (CIT) and late night surgery. Methods. 1262 deceased donor kidney transplantations were analyzed. Multivariable regression was used to determine odds ratios (ORs) for reoperation, graft loss, delayed graft function (DGF), and discharge on dialysis. CIT was categorized according to a forward stepwise pattern ≤1h/>1h, ≤2h/>2h, ≤3h/>3h,…, ≤nh/>nh. ORs for DGF were plotted against CIT and a nonlinear regression function with best R2 was identified. First and second derivative were then implemented into the curvature formula k(x)=f′′(x)/(1+f′x2)3/2 to determine the point of highest CIT-mediated risk acceleration. Results. Surgery between 3 AM and 6 AM is an independent risk factor for reoperation and graft loss, whereas prolonged CIT is only relevant for DGF. CIT-mediated risk for DGF follows an exponential pattern fx=A·(1+k·eI·x) with a cut-off for the highest risk increment at 23.5 hours. Conclusions. The risk of surgery at 3 AM–6 AM outweighs prolonged CIT when confined within 23.5 hours as determined by a new mathematical approach to calculate turning points of nonlinear time related risks. CIT is only relevant for the endpoint of DGF but had no impact on discharge on dialysis, reoperation, or graft loss.http://dx.doi.org/10.1155/2017/5362704 |
| spellingShingle | Nikos Emmanouilidis Julius Boeckler Bastian P. Ringe Alexander Kaltenborn Frank Lehner Hans Friedrich Koch Jürgen Klempnauer Harald Schrem Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss Journal of Transplantation |
| title | Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss |
| title_full | Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss |
| title_fullStr | Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss |
| title_full_unstemmed | Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss |
| title_short | Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss |
| title_sort | risk balancing of cold ischemic time against night shift surgery possibly reduces rates of reoperation and perioperative graft loss |
| url | http://dx.doi.org/10.1155/2017/5362704 |
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