Evaluating the impact of structured reporting for post-operative ultrasound on management and survival in liver transplant patients

Thesis

Liver transplantation has the potential for life saving results in patients with end-stage liver disease. Transplantation is however a complex procedure that requires early post-surgical monitoring with ultrasound (US) to improve the chances of success. The communication of US results before and after the introduction of a structured reporting template was assessed to determine if the change in reporting practices impacted on the management patients and their survival following liver transplant. 125 patients from before and 112 patients from after the introduction of the template were analysed. The changes in frequency of reporting of key components of the liver US, the use of computed tomography (CT) within 30 days, re-operation within 30 days and survival were assessed using logistic regression for binary outcomes and Kaplan-Meier and Cox regression for time-to-event analyses. After the introduction of structured reporting, there were increases in the communication of the presence or absence of ascites, portal vein flow direction and patency of the splenic vein. There were also increases in the use of CT, OR 2.2 (95% CI 1.3-3.8) and in the likelihood of CT detecting a vascular abnormality, OR 1.05 (95% CI 1.01 to 1.09). The likelihood of re-operation also increased, OR 2.2 (95% CI 1.1 to 4.7). No difference was found in early survival before and after the US template introduction (Barlow p-value = 0.077), but the longer-term survival of the post template group was lower (Log rank p-value = 0.007 and Taron-Ware p-value = 0.027). These results show that structured reporting affects key components of US report communication and that there are changes in further imaging and surgical management decisions and to long-term survival that could be related to the communication changes. Careful consideration should therefore be given to the composition of any structured reporting templates before implementation

Authors: Deen, S

• DOI: 10.5287/ora-yedpmrnpr
• Type of award: MSc
• Level of award: Masters
• Awarding institution: University of Oxford
• Language: English
• Keywords: structured radiology reporting; template reporting; radiology; liver transplant; liver ultrasound
• Subjects: Graft rejection; Radiology; Transplant surgeons; Doppler ultrasonography; Transplantation of organs, tissues, etc.