A96 PERIOPERATIVE RATE OF CHANGE IN SODIUM CONCENTRATION AND ITS IMPACT ON LENGTH OF STAY IN CRITICAL CARE UNIT POST LIVER TRANSPLANTATION: BENCHMARKING FOR QUALITY MANAGEMENT PROGRAM
Bibliographic record
Abstract
Abstract Aims The aim of this quality improvement project was to benchmark the rate of change in serum sodium (delta-Na) in the perioperative period for liver transplantation (OLT) to correlate it with neurological complications as well as length of stay in critical care unit. Methods Data for total of 46 patients who underwent liver transplantation in Halifax between January 2015 and December 2016 were extracted from Atlantic Multi-Organ Transplant Program and QEII-HSC Information Systems. Pre-operative, immediate post-operative and 24–48 hours post-operative serum sodium concentrations were entered into EXCEL worksheet. In addition post-transplant neurological complications were identified in addition to length of stay in critical care unit. Results During the review period, 23 males and 23 females underwent OLT. Their mean age was 56 yrs (ranging from 23 - 70 yrs). The primary indication for transplantation was cirrhosis (57%) and hepatocellular carcinoma (35%). Fatty liver disease was most common etiology for cirrhosis (46%), followed by PBC (27%), Alcohol-related (15%). Average natural MELD-Na score was 20 (with a range from 7 – 41). Average OR time was 7hr 23min (range 4hr 15min – 15hr). In 22% of patients, the rate of delta-Na levels were rapid (more than 8 mEq/L) between the pre-operative and immediate post-operative period. Only 2% of patients had more than 8 mEq/L change in their serum sodium levels between the first and second post-operative days. Prior to OLT 21 (46%) patients had hepatic encephalopathy but this was mild or controlled in the majority of patients. In 8 (17%) patients there was multiple-etiology encephalopathy/delirium in the post-operative period. None of these patients developed neurological deficits. Only in 3 patients, tremors were documented (probably multifactorial including calcineurin-inhibitor toxicity). In this project, none of these findings correlated with a high rate of delta-Na. The average number of days in critical care unit was 6 (range 1 – 62 days). There was no clear correlation between length of stay (surrogate marker for neurologic complications) and rate of delta-Na. Conclusions In this benchmarking project, we were unable to identify a specific cut-off rate for delta-Na to correlate with either neurologic complication or length of stay in critical care unit. Rapid correction of serum sodium is often associated with various neurologic complications including central pontine myelinosis. Larger data-base with more numbers of liver transplant patients are needed to show any significant relationship and optimize the electrolyte and volume management. Rapid change in serum sodium could not help with our attempt to classify this benchmarking metric into one of four categories: productivity, quality, time and cost-related. Funding Agencies NoneKEVORK M PELTEKIAN
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".