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July 10, 2008 (法国巴黎) — 肝脏移植时评估提供麻醉的模式显示，专属的麻醉团队减少手术时、手术后的输血与机械辅助呼吸的需要，也减少病患的手术时间、以及缩短加护病房和住院天数。
威斯康辛大学麻醉移植服务主任、麻醉科医学与公共卫生副教授Zoltan Hevesi医师，在ILTS, ELITA & LICAGE 2008年国际联合研讨会中发表研究结果。
Hevesi医师向Medscape Transplantation表示，有越来越多的研究指出，美国各地的健康照护品质存在有相当大的变化，造成医疗实务的差异，而这些与病患原本的医疗状况无关。Hevesi医师引述大学健康体系协会(University Health System Consortium)在2003年的一项调查，指出各国之间，肝脏移植前后的实务有显著不同。他解释，在美国的麻醉小组，麻醉成员的适当水准是一种传统的困境。
评估他们自己在2003年的实务之后，威斯康辛大学的肝脏移植者实施一项连续品质改善(CQI)计划，评估分派给肝脏移植接受者的资源；该团队定期检视一些资源分派终点，包括病患使用的红血球(RBC)和新鲜冷冻血浆(FFP)的数量、花在手术室和加护病房的时间、使用机械辅助呼吸的时间、以及住院天数。
计划管理者连续实施证据基础的麻醉临床规范，且雇用一个移植麻醉主任；为了改善资源分派终点，这名主任建立一个专责的肝脏移植团队，增加麻醉医师在移植服务里面的功能。
Hevesi医师等人比较CQI 计划实施前、2000至2002年间217名移植病患的资源分配，和计划实施后、2005年87名移植病患的资源分配；虽然两组之间在病患重病分数、手术团队组成、手术技术等方面都类似，但在全部6个资源分配终点，测得计划实施后的病患需要较少的资源 (P<.05)。
CQI实施后的病患，所需要的RBC数量仅为CQI实施前的三分之一 (5.2 ± 5.4 单位 vs. 14.9 ± 16.9 单位)，而CQI实施前病患需要的FFP量是实施后的8倍(29.1 ± 21.2单位 vs.3.4 ± 4.7 单位)；CQI实施后的病患，花在手术室的时间平均减少63分钟(469 ± 160分钟 vs. 532 ± 181 分钟) ，手术后住在加护病房的天数减少1.5天(3.0 ± 4.1天vs. 4.5 ± 6.1天)；CQI实施后的病患，移除机械式辅助呼吸的天数平均提早1天(1.3 ± 3.3天vs. 2.3 ± 4.5天) ，住院天数平均缩短9天(14.0 ± 10.3天vs. 23.1 ± 23.6 天)。
会议主持人、Baylor研究中心总裁、Baylor大学医学中心麻醉与疼痛处理服务主任Michael Ramsay医师向Medscape Transplantation表示，此研究发现有其意义；Ramsay医师解释，专责团队的确会被你视为一种小事，显然地，当你有高度紧急照护需求，一如进行肝脏移植，就会有很大差异；这些人有较多经验，当你进行特定策略和规范时，步调一致。
Hevesi医师预测，威斯康辛大学的逐步变革可以作为类似机构的挑战范例，也指出此一计划可以自给自足；Hevesi 医师结论表示，在威斯康辛大学，显著降低的输血和缩短住院天数，远远可以应付专责肝脏移植麻醉团队的花费。
本研究未接受商业补助。Hevesi医师和Ramsay医师宣称无相关资金上的往来。
ILTS, ELITA & LICAGE 2008年国际联合研讨会 ：摘要 506。发表于2008年7月10日。
Designated Anesthesia Team for Liver Transplants Conserves Resources While Preserving Patient Outcomes
By Bryan DeBusk, PhD
Medscape Medical News
July 10, 2008 (Paris, France) — The evaluation of a model for providing anesthesia during liver transplants has shown that a dedicated anesthesia team reduces the need for blood transfusions and mechanical ventilation during and after surgery and is associated with decreases in the time patients spend in the operating room, in intensive care, and in the hospital.
Zoltan Hevesi, MD, associate professor of medicine and public health in the department of anesthesiology, and director of anesthesiology transplantation services at the University of Wisconsin, in Madison, presented the results of the study here at the 2008 Joint International Congress of ILTS, ELITA & LICAGE.
"A growing body of research confirms the existence of wide variations [in healthcare quality across the United States], which are attributable to differences in medical practices and are unrelated to the patient's preexisting medical condition," Dr. Hevesi told Medscape Transplantation. Dr. Hevesi cited a 2003 survey by the University Health System Consortium that revealed marked differences in perioperative liver transplant practices across the country. "Allocating the right level of anesthesiology personnel is a classic dilemma for a number of anesthesiology groups in the United States," he explained.
After evaluating their own practices in 2003, liver transplant personnel at the University of Wisconsin implemented a continuous quality-improvement (CQI) program for evaluating resource allocation to liver transplant recipients. The group periodically examined a number of resource-allocation end points, including the number of red blood cell (RBC) and fresh frozen plasma (FFP) units patients received, time spent in the operating room and intensive care, time spent on mechanical ventilation, and length of hospital stay.
Program administrators sequentially implemented evidence-based clinical guidelines for anesthesia and hired a director of transplant anesthesia. To improve resource-allocation end points, the director established a dedicated liver transplant team and increased the involvement of anesthesiologists in the function of the transplant service line.
Dr. Hevesi and his colleagues compared the allocation of resources to 217 transplant recipients before (from 2000 to 2002) and to 87 transplant recipients after (in 2005) the CQI program was implemented. Although patient illness severity scores, surgical group composition, and surgical technique were comparable between the 2 groups, patients treated after the program was implemented required fewer resources, as measured by all 6 resource-allocation end points (P?< .05).
Patients in the post-CQI group required only about a third as many RBC units as those in the pre-CQI group (5.2 ± 5.4 units vs 14.9 ± 16.9 units), and patients in the pre-CQI group required more than 8 times as many FFP units (29.1 ± 21.2 units vs 3.4 ± 4.7 units). Patients in the post-CQI group spent an average of 63 minutes less in the operating room (469 ± 160 minutes vs 532 ± 181 minutes) and 1.5 fewer days in intensive care after surgery (3.0 ± 4.1 days vs 4.5 ± 6.1 days). Mechanical ventilation was removed an average of 1 day earlier (1.3 ± 3.3 days vs 2.3 ± 4.5) in the post-CQI group, and hospital stays were an average of 9 days shorter (14.0 ± 10.3 days vs 23.1 ± 23.6 days).
Michael Ramsay, MD, moderator of the session, president of the Baylor Research Institute, and chief of service for the department of anesthesiology and pain management at Baylor University Medical Center, in Dallas, Texas, told Medscape Transplantation that the findings make sense. "It's really the sort of thing you'd expect with a small, dedicated group," Dr. Ramsay explained. "Clearly, when you have high acute-care needs, [as patients undergoing liver transplants do], it makes a big difference. These people have more experience, and they are all on the same page when you implement specific policies and protocols."
Dr. Hevesi predicted that the gradual transformation at the University of Wisconsin will serve as an example for institutions with similar challenges, and noted that the program will likely pay for itself. "At the University of Wisconsin, the significantly reduced blood transfusions and shorter hospital stays more than covered the additional costs of maintaining a dedicated liver transplant anesthesia team," Dr. Hevesi concluded.
This study did not receive commercial support. Drs. Hevesi and Ramsay have disclosed no relevant financial relationships.
2008 Joint International Congress of ILTS, ELITA & LICAGE: Abstract 506. Presented July 10, 2008.