Abstract
Introduction
Procedures such as liver transplantation, which entail large costs while benefiting only a small percentage of the population, are being increasingly scrutinized by third-party payors. The purpose of our study was to conduct a longitudinal analysis of the early clinical outcomes and health care resource utilization for liver transplantation in the United States.
Methods
The Nationwide Inpatient Sample database was used to conduct a longitudinal analysis of the clinical outcome and resource utilization data for liver transplantation procedures in adult recipients performed in the United States over three time periods (Period I: 1988–1993; Period II: 1994–1998: Period III: 1999–2003).
Results
Compared to Period I, adult liver transplant recipients were more likely to be male, older, and non-White in Period III. Recipients were more likely to have at least one major comorbidity preoperatively than in Period I. The in-hospital mortality rate after liver transplantation decreased significantly from Period I to Period III, but the major intraoperative and postoperative complication rates increased over the same time period. Mean length of hospital stay decreased over the 15-year period, but the percentage of patients with a non-routine discharge status increased.
Conclusion
Our findings indicate that the rate of postoperative complications and non-routine discharges after liver transplantation is increasing. However, these negative changes in the cost–outcomes relationship for liver transplantation are balanced by improving postoperative survival rates and reductions in the length of hospital stay.
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References
Brown, R. S., Ascher, N. L., Lake, J. R., Emond, J. C., Bacchetti, P., Randall, H. B., et al. (1997). The impact of surgical complications after liver transplantation on resource utilization. Archives of Surgery, 132(10), 1098–1103.
Brown, R. S., Lake, J. R., Ascher, N. L., Emond, J. C., & Roberts, J. P. (1998). Predictors of the cost of liver transplantation. Liver Transplantation and Surgery, 4, 170–176.
Brown, R. S., Rush, S. H., Rosen, H. R., Langnas, A. N., Klintmalm, G. B, Hanto, D. W., et al. (2004). Liver and intestine transplantation. American Journal of Transplants, 4(Suppl 9), 81–92.
Busuttil, R. W., Yersiz, H., Hiatt, J. R., McDiarmid, S. V., Goldstein, L. I., Saab, S., et al. (2005). Analysis of long-term outcomes of 3200 liver transplantation over two decades: A single-center experience. Annals of Surgery, 241, 905–916.
Charlson, M. E., Pompei P, Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40, 373–383.
Comparative Analysis of HCUP and NHDS Inpatient Discharge Data. Technical Supplement 13, NIS Release 5. Rockville, MD: Agency for Health Care Policy and Research. Available from: URL: http://www.ahrq.gov/data/hcup/niscomp.htm. Accessed September 2005.
Cortazzo, M. H., Helkowski, W., Pippin B, Boninger, M. L., & Zafonte R. (2005). Acute inpatient rehabilitation of 55 patients after liver transplantation. American Journal of Physical Medicine & Rehabilitation, 84(11), 880–884.
Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology, 45, 613–619.
Eckhoff, D. E., McGuire, B. M., Young L., Sellers, M. T., Frenette, L., Hudson, S. L., et al. (2000). Liver transplantation in the era of cost constraints. Southern Medical Journal, 93(4), 392–396.
Englehardt, H. T. (1984). Shattuck Lecture—Allocating scarce medical resources and the availability of organ transplantation. New England Journal of Medicine, 311(1), 66–71.
Evans, R. W., Manninen, D. L., & Dong, F. B. (1993). An economic analysis of liver transplantation: Costs, insurance coverage, and reimbursement. Gastroenterology Clinics of North America, 22(2), 451–473.
Falagas, M. E., Arbo, M., Ruthazer, R., Griffith, J. L., Rohrer, R., Freeman, R., et al. (1997). Cytomegalovirus disease is associated with increased cost and hospital length of stay among orthotopic liver transplant recipients. Transplantation, 63, 1595–1601.
Filipponi, F., Pisati, R., Cavicchini, G., Ulivieri, M. I., Ferrara, R., & Mosca, F. (2003). Cost and outcome analysis and cost determinants of liver transplantation in a European National Health Service hospital. Transplantaion, 75(10), 1731–1736.
Gilbert, J. R., Pascual, M., Schoenfeld, D. A., Rubin, R. H., Delmonico, F. L., & Cosimi, A. B. (1999). Evolving trends in liver transplantation: an outcome and charge analysis. Transplantation, 67(2), 246–253.
Harrison, D. M., Stewart, A. S., Koneru, B., & Holman, M. J. (1996). Reduction in hospital stay after liver transplantation. Transplantation Proceedings, 28(2), 896.
HCUP quality control procedures. Agency for Healthcare Research and Quality, Rockville, MD. Available from: URL: http://www.ahrq.gov/data/hcup/sasddocu/techsupp2.pdf. Accessed September 2005.
Hemming, A. W., Caltral, M. S., Greig, P. D., et al. (1998). A pharmacoeconomic analysis of neural without intravenous cyclosporine in liver transplantation in Canada. Clinical Transplantation, 12(5), 425–429.
Hollenbeak, C. S., Alfrey, E. J., & Souba, W. W. (2001). The effect of surgical site infections on outcomes and resource utilization after liver transplantation. Surgery, 130(2), 388–395.
Hosein Shokouh-Amiri, M., Osama Gaber, A., Bagous, W. A., Grewal, H. P., Hathaway, D. K., Vera, S. R., et al. (2000). Choice of surgical technique influences perioperative outcomes in liver transplantation. Annals of Surgery, 231(6), 814–823.
International Classification of Diseases, (2002). Ninth Revision, Clinical Modification. Los Angeles: Practice Management Information Corporation.
Jain, A., Reyes, J., Kashyap, R., Rohal, S., Cacclorelli, T. McMicheal, J., et al. (2000). Long-term survival after liver transplantation in 4,000 consecutive patients at a single center. Annals of Surgery, 232(4), 490–500.
Kankaanpaa, J. (1990). Cost-effectiveness of liver transplantation—How to apply the results in resource allocation. Preventive Medicine, 19, 700.
Kim, W. R., Badley, A. D., Wiesner, R. H., Porayko, M. K., Seaberg, E. C., Keating, M. R., et al. (2000). The economic impact of cytomegalovirus infection after liver transplantation. Transplantation, 69(3), 357–361.
Kim, W. R., Therneau, T. M., Dickson, E. R., & Evans, R. W. (1995). Preoperative predictors of resource utilization in liver transplantation. Clinical Transplants, 315–322.
Lake, J. R., Gorman, K. J., Esquivel, C. O., Wiesner, R. H., Klintmalm, G. B., Miller, C. M., et al. (1995). The impact of immunosuppressive regimens on the cost of liver transplantation: Results from the United States FK506 multicenter trial. Transplantation, 60, 1089.
Markmann, J. F., Markmann, J. W., Markmann, D. A., Bacquerizo, A., Singer, J., Holt, C. D., et al. (2001). Preoperative factors associated with outcome and their impact on resources in 1148 consecutive primary liver transplants. Transplantation, 72, 1113–1122.
Merion, R. M. (1997). Prostaglandins in liver transplantation. Advances in Experimental Medicine and Biology, 433, 13–18.
NIS Technical Documentation. Agency for Healthcare Research and Quality, Rockville, MD. Available from: URL: http://www.ahrq.gov/data/hcup/nis.htm. Accessed September 2005.
Oostenbrink, J. B., Kok, E. T., & Verheol, R. M. (2005). A comparative study of resource use and costs of renal, liver, and heart transplantation. Transplant International, 18(4), 437–443.
Organ Procurement and Transplantation Network 2005 Annual Report, http://www.optn.org/AR2005, accessed March 4, 2006.
Overview of the HCUP Nationwide Inpatient Sample (NIS). Agency for Healthcare Research and Quality, Rockville, MD. Available from: URL: http://www.ahcpr.gov/data/hcup/nisdoc00/Overview_of_NIS_2000.pdf. Accessed September 2005.
Payne, J. L., McCarty, K. R., Drougas, J. G., Chapman, W. C., Wright, J. K., & Pinson, N. Y. (1996). Outcomes analysis for 50 liver recipients: The Vanderbilt experience. American Surgeon, 62, 320–325.
Quiroga, M., Rodriguez, M. G., Montalvan, C, Abarca, J., Vinuela, M., Cavallieri, S., et al. (2004). Trends in mechanical ventilation and immediate extubation after liver transplantation in a single center in Chile. Transplantation Proceedings, 36(6), 1683–1684.
Showstack, J, Katz, P. P., Lake, J. R., Brown, R. S. Jr., Dudley, R. A., Belle, S., et al. (1999). Resource utilization in liver transplantation. Journal of the American Medical Association, 281(15), 1381–1386.
Spanier, T. B., Klein, R. D., Nasraway, S. A., Rand, W. M., Rohrer, R. J., Freeman, R. B., et al. (1995). Multiple organ failure after liver transplantation. Critical Care Medicine, 23(3), 466–473.
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Paper presented at the Annual Meeting of the American Hepato-Pancreatico-Biliary Association on Friday, March 10, 2006, in Miami Beach, Miami.
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Scarborough, J.E., Pietrobon, R., Marroquin, C.E. et al. Temporal Trends in Early Clinical Outcomes and Health Care Resource Utilization for Liver Transplantation in the United States. J Gastrointest Surg 11, 82–88 (2007). https://doi.org/10.1007/s11605-007-0103-5
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DOI: https://doi.org/10.1007/s11605-007-0103-5