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

• Published in: Journal of gastrointestinal surgery Vol. 19; no. 2; pp. 282 - 289
• Main Authors: Palanisamy, Arun P., Taber, D. J., Sutter, A. G., Nadig, S. N., Dowden, J. E., McGillicuddy, J. W., Baliga, P. K., Chavin, K. D.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.02.2015; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Biliary Tract Diseases - economics; Biliary Tract Diseases - etiology; Clinical outcomes; Cross-Sectional Studies; Direct Service Costs; Drug Costs; Female; Gastroenterology; Health Care Costs; Hospital Costs; Hospital Mortality; Humans; Intensive Care Units; Length of Stay; Liver Transplantation - adverse effects; Liver Transplantation - mortality; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Patient Readmission; Retrospective Studies; Risk Factors; Surgery; Young Adult; Biliary complications; Costs; Clinical outcomes; Liver transplantation
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-014-2675-1

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.