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Journal of Transplantation
Volume 2017, Article ID 5362704, 16 pages
https://doi.org/10.1155/2017/5362704
Research Article

Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss

1General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
2Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
3Trauma and Orthopedic Surgery, Federal Armed Forces Hospital, Westerstede, Germany

Correspondence should be addressed to Nikos Emmanouilidis; ed.revonnah-hm@sokin.sidiliuonamme

Received 9 September 2016; Accepted 4 December 2016; Published 19 January 2017

Academic Editor: Simon C. Robson

Copyright © 2017 Nikos Emmanouilidis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Supplementary Material

The supplemental table shows the detailed descriptive statistics of donor and recipient related covariables of the 25 individuals that were transplanted between 3AM-6AM as well as proportions and distributions of the corresponding data of all patients that were transplanted outside the 3AM-6AM time interval. Normality of distribution of continuous data was analyzed with the Anderson-Darling Test (p < 0.05 indicated a non-normal distribution of data). The proportions of categorial variables and distribution of continuous in- and output data were compared between these two groups using the Fisher’s exact Test or the Levene’s Test were appropriate. Analyzed were the donor related variables donor-age, BMI, Urea, Creatinine, Sodium(Na+), Potassium (K+), 24h urine production and urine production of the last hour and the recipient related variables age, BMI, operating time (OT), cold ischemic time (CIT), anastomosis time (AT), >1 arterial anastomosis [yes/no], ureter stenting [yes/no], 1st Surgeons CUSUM, and the output variates reoperation[yes/no], perioperative graft loss[yes/no], surgery related perioperative graft loss[yes/no], postoperative dialysis[yes/no]and discharge on dialysis[yes/no]. There were no significant differences between the two groups with respect to the analyzed donor data (p > 0.200, Leven’s Test). There were also no significant differences comparing the recipient related variables age, BMI, operating time (OT), anastomosis time (AT), >1 arterial anastomosis [yes/no], ureter stenting [yes/no], and 1st Surgeons CUSUM. The only variable which was significantly different was cold ischemic time (CIT), which was shorter in the 3AM-6AM interval group (median=725, mean=903 , SD=542) as compared to the group of patients that were transplanted outside the 3AM-6AM time interval (median=860, mean=917, SD=367) (p=0.004, Levene’s Test). The rate of perioperative graft loss due to surgical reasons was significantly higher in the 3AM-6AM interval group as compared to the group of patients that were transplanted outside the 3AM-6AM time interval (12% vs. 1.4%, Fisher’s Exact Test p=0.007). The 3AM-6AM interval group also had higher rates of reoperation (32% vs 17%) and discharge on dialysis (25% vs 11%) as compared to the group of patients that were transplanted outside the 3AM-6AM time interval, but the differences were slightly above the significance level of 0.050 (Fisher’s Exact Test, p=0.060 and p=0.056, respectively).

The supplemental figure a) shows a X2-test comparing the proportions of teaching operations between the 3h day- and night-time intervals. The proportion of teaching operations during the critical hours from 3AM-6AM was neither different to the extrema with lowest proportions of teaching operations (9PM-12AM) nor to the extrema with highest proportion of teaching operations (6AM-9AM) and also not different to any other 3h interval.

Supplemental figure b) shows a comparison of the 3h day- and night-time intervals with respect to the variances of the 1st surgeon’s CUSUM. There was no significant differences between any of the compared 3h-time intervals (Leven’s test p=0.627).

The supplemental material shows that there was no data disparity or data bias that possibly could have compromised the analyses or the conclusions that were drawn. Moreover, the fact that CIT was significantly shorter (!) in the 3AM-6AM time interval group and that this group was more vulnerable for reoperation und surgery related complications strengthens the conclusion that unnecessarily performed kidney transplantations during high-risk morning hours with the only intention to reduce CIT, but at the expense of surgical quality, might be a bad decision. Especially as prolonged CIT only impacts on the endpoint of delayed graft function, but not on perioperative graft loss, reoperation and discharge on dialysis.

  1. Supplementary Material