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Clinical Outcomes and Costs Associated with In-hospital Biliary Complications After Liver Transplantation: a Cross-Sectional Analysis

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

In-hospital biliary complications (BCs) after liver transplantation (LT) are reported in up to 20 % of patients and contribute to poor outcomes and increased costs. Existing single-center outcome and cost analyses studies are limited in scope.

Methods

This is a cross-sectional analysis of national data involving 7,967 patients transplanted between 2011 and 2012 with the primary aim of determining the association between BCs and clinical outcomes and costs. Age, race, diagnosis, and severity of illness are associated with the development of BCs.

Results

BCs develop in 14.6 % of LT recipients and have substantial implications for perioperative outcomes, including length of hospital and ICU stay (27.9 vs 19.6 mean days, p < 0.001 and 12.0 vs 8.3 mean days, p < 0.001, respectively), in-hospital morbidity (39 vs 27 %, p < 0.001), 30-day readmissions (14.8 vs 11.2 %, p < 0.001), and in-hospital mortality (5.8 vs 4.0 %, p < 0.001). BCs contributed to a mean increase in in-hospital costs of $36,212 (p < 0.001), due to increases in accommodations ($9,539, p < 0.001), surgical services ($3,988, p < 0.001), and pharmacy services ($8,445, p < 0.001).

Discussion

BCs are a predominant etiology for in-hospital morbidity and mortality, while contributing significantly to the high cost of LT. Efforts should be focused on understanding salient and modifiable risk factors, while developing innovative strategies to reduce BCs.

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Abbreviations

BCs:

Biliary complications

LT:

Liver transplantation

DCD:

Donation after cardiac death

UHC:

University HealthSystem Consortium

ICU:

Intensive care unit

LOS:

Length of stay

GI:

Gastrointestinal

NEC:

Not elsewhere classified

NOS:

Not otherwise specified

ICD-9:

International Statistical Classification of Diseases and Related Health Problems

US:

United States

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Acknowledgments

No extramural funding source associated with this study.

Conflict of Interest

No authors have any competing interests. An ethics statement was not required for this work.

Author information

Authors and Affiliations

  1. Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 412, Charleston, SC, 29425, USA

    Arun P. Palanisamy, D. J. Taber, A. G. Sutter, S. N. Nadig, J. E. Dowden, J. W. McGillicuddy, P. K. Baliga & K. D. Chavin

  2. Division of Transplant, Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, 409 CSB, PO Box 250611, Charleston, SC, 29425-0611, USA

    Arun P. Palanisamy

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  1. Arun P. Palanisamy
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  2. D. J. Taber
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  3. A. G. Sutter
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  4. S. N. Nadig
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  5. J. E. Dowden
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  6. J. W. McGillicuddy
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  7. P. K. Baliga
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  8. K. D. Chavin
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Corresponding author

Correspondence to Arun P. Palanisamy.

Additional information

Arun P. Palanisamy and D. J. Taber contributed equally to this work.

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Palanisamy, A.P., Taber, D.J., Sutter, A.G. et al. Clinical Outcomes and Costs Associated with In-hospital Biliary Complications After Liver Transplantation: a Cross-Sectional Analysis. J Gastrointest Surg 19, 282–289 (2015). https://doi.org/10.1007/s11605-014-2675-1

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  • DOI: https://doi.org/10.1007/s11605-014-2675-1

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