Evolving trends in liver transplantation: an outcome and charge analysis

Détails

ID Serval
serval:BIB_DC7FDBDAE27B
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Evolving trends in liver transplantation: an outcome and charge analysis
Périodique
Transplantation
Auteur(s)
Gilbert  J. R., Pascual  M., Schoenfeld  D. A., Rubin  R. H., Delmonico  F. L., Cosimi  A. B.
ISSN
0041-1337
Statut éditorial
Publié
Date de publication
01/1999
Peer-reviewed
Oui
Volume
67
Numéro
2
Pages
246-53
Notes
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't --- Old month value: Jan 27
Résumé
BACKGROUND: Due to the limited supply and increased demand for donor livers, waiting times are progressively lengthening, which may lead to transplantation at more advanced and less cost-effective stages of disease. The purpose of this study was to evaluate the outcomes and hospital charges of liver transplantation during two recent eras to identify areas for providing more cost-effective care. METHODS: A total of 144 primary liver allografts were performed from 1991 to 1996. Patient characteristics, outcome measures, and hospital charges were compared for patients receiving allografts between 1991 and 1993 (group A) versus those receiving grafts between 1994 and 1996 (group B) using unpaired Student t tests for continuous data and chi-squared tests for categorical data. RESULTS: In comparing groups A and B, no significant differences in patient demographics, relative contraindications, or indication for transplantation existed; median waiting time from date of listing until transplant increased from 88 days to 159 days; and a shift in UNOS priority status at time of transplantation occurred, as the percentage of patients requiring inpatient care increased from 58% to 75% (P=0.034). Despite this, patient hospital and 1-year survival significantly improved from 75.0% to 90.3% (P=0.016), and from 68.1% to 88.9% (P=0.002), respectively. Total hospital charges, without correction for inflation, were $174,908+/-16,388 in A and $193,525+/-14,444 in B (P=0.288). The increased charges were associated with longer inpatient length of stay (LOS) before transplant, resulting in increased pretransplant charges from $24,088+/-4134 (A) to $39,490+/-6,196 (B) (P=0.011). Room and service (54%) was the largest pretransplant contributor to charges, while blood products (23%), room and service (21%), organ acquisition (13%), and operating room charges (11%) contributed the most after transplant. CONCLUSIONS: Longer waiting times resulting in transplantation at later stages of disease have occurred, leading to longer pretransplant LOS and its associated charges. Despite more advanced disease, patient survival rates have significantly improved with fewer infection-related deaths. LOS pretransplant, blood products, and operating room services represent potential areas for providing more cost-effective care.
Mots-clé
Adolescent Adult Aged Boston Chi-Square Distribution Child Child, Preschool Demography Female Humans Infant Liver Diseases/classification/surgery Liver Transplantation/contraindications/mortality/*trends Male Middle Aged Retrospective Studies Survival Rate Time Factors Waiting Lists
Pubmed
Web of science
Création de la notice
29/01/2008 13:52
Dernière modification de la notice
20/08/2019 16:01
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