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We defined TO for kidney transplantation using a cohort from a high\u2010volume institution.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adult patients who underwent isolated kidney transplantation at our institution between 2016 and 2019 were included. TO was defined by clinician consensus at our institution to include freedom from intraoperative complication, postoperative reintervention, 30\u2010day intensive care unit or hospital readmission, length of stay\u2009&gt;\u200975th percentile of kidney transplant patients, 90\u2010day mortality, 30\u2010day acute rejection, delayed graft function, and discharge with a Foley catheter. Recipient, operative, financial characteristics, and post\u2010transplant patient, graft, and rejection\u2010free survival were compared between patients who achieved and failed to achieve TO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 557 kidney transplant patients were included. Of those, 245 (44%) achieved TO. The most common reasons for TO failure were delayed graft function (<jats:italic>N<\/jats:italic>\u2009=\u2009157, 50%) and hospital readmission within 30\u00a0days (<jats:italic>N<\/jats:italic>\u2009=\u2009155, 50%); the least common was mortality within 90\u00a0days (<jats:italic>N<\/jats:italic>\u2009=\u20096, 2%). Patient, graft, and rejection\u2010free survival were significantly improved among patients who achieved TO. On average, patients who achieved TO incurred approximately $50,000 less in total inpatient charges compared to those who failed TO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>TO in kidney transplantation was associated with favorable post\u2010transplant outcomes and significant cost\u2010savings. TO may offer transplant centers a detailed performance breakdown to identify aspects of perioperative care in need of process improvement.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-020-05943-y","type":"journal-article","created":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T22:02:33Z","timestamp":1611439353000},"page":"1504-1513","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Definition and Analysis of Textbook Outcome: A Novel Quality Measure in Kidney Transplantation"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7316-1989","authenticated-orcid":false,"given":"Samantha E.","family":"Halpern","sequence":"first","affiliation":[{"name":"Department of Surgery Duke University Medical Center Box 3512 27710 Durham NC 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