Anesthesia for liver transplantation in US academic centers: Institutional structure and perioperative care

Authors

  • Ann Walia,

    Corresponding author
    1. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
    2. Department of Anesthesiology and Perioperative Care, Tennessee Valley Healthcare System, Nashville TN
    • Tennessee Valley Healthcare System, 1310 24th Avenue South, Nashville, TN 37212
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    • Telephone: 615-873-7268; FAX: 615-873-7821

  • M. Susan Mandell,

    1. Department of Anesthesiology, University of Colorado, Aurora CO
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  • Nathaniel Mercaldo,

    1. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
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  • Damon Michaels,

    1. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
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  • Amy Robertson,

    1. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
    2. Department of Anesthesiology and Perioperative Care, Tennessee Valley Healthcare System, Nashville TN
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  • Arna Banerjee,

    1. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
    2. Department of Anesthesiology and Perioperative Care, Tennessee Valley Healthcare System, Nashville TN
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  • Ramachander Pai,

    1. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
    2. Department of Anesthesiology and Perioperative Care, Tennessee Valley Healthcare System, Nashville TN
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  • John Klinck,

    1. Division of Perioperative Care, Cambridge University Hospitals, Cambridge, UK, Tufts School of Medicine, Boston MA
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  • Matthew Weinger,

    1. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
    2. Department of Anesthesiology and Perioperative Care, Tennessee Valley Healthcare System, Nashville TN
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  • Pratik Pandharipande,

    1. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
    2. Department of Anesthesiology and Perioperative Care, Tennessee Valley Healthcare System, Nashville TN
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  • Roman Schumann

    1. Department of Anesthesiology, Tufts Medical Center, Tufts School of Medicine, Boston MA
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  • This study was supported by an educational grant from the Department of Anesthesiology at Vanderbilt University Medical Center (Nashville, TN).

Abstract

Investigators at a single institution have shown that the organization of the anesthesia team influences patient outcomes after liver transplant surgery. Little is known about how liver transplant anesthesiologists are organized to deliver care throughout the United States. Therefore, we collected quantitative survey data from adult liver transplant programs in good standing with national governing agencies so that we could describe team structure and duties. Information was collected from 2 surveys in a series of quantitative surveys conducted by the Liver Transplant Anesthesia Consortium. All data related to duties, criteria for team membership, interactions/communication with the multidisciplinary team, and service availability were collected and summarized. Thirty-four of 119 registered transplant centers were excluded (21 pediatric centers and 13 centers not certified by national governing agencies). Private practice sites (26) were later excluded because of a poor response rate. There were minimal changes in the compositions of the programs between the 2 surveys. All academic programs had distinct liver transplant anesthesia teams. Most had set criteria for membership and protocols outlining the preoperative evaluation, attended selection committees, and were always available for transplant surgery. Fewer were involved in postoperative care or were available for patients needing subsequent surgery. Most trends were associated with the center volume. In conclusion, some of the variance in team structure and responsibilities is probably related to resources available at the site of practice. However, similarities in specific duties across all teams suggest some degree of self-initiated specialization. Liver Transpl, 2012. © 2012 AASLD.

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