title: Resource utilization in liver transplantation: effects of patient characteristics and clinical practice. NIDDK Liver Transplantation Database Group.
abstract: BACKGROUND
  Liver transplantation is among the most costly of medical services, yet few studies have addressed the relationship between the resources utilized for this procedure and specific patient characteristics and clinical practices.
  
  
  OBJECTIVE
  To assess the association of pretransplant patient characteristics and clinical practices with hospital resource utilization.
  
  
  METHODS
  Prospective cohort of patients who received liver transplants between January 1991 and July 1994.
  
  
  METHODS
  University of California, San Francisco; Mayo Clinic, Rochester, Minn; and the University of Nebraska, Omaha.
  
  
  METHODS
  Seven hundred eleven patients who received single-organ liver transplants, were at least 16 years old, and had nonfulminant liver disease.
  
  
  METHODS
  Standardized resource utilization derived from a database created by matching all services to a single price list.
  
  
  RESULTS
  Higher adjusted resource utilization was associated with donor age of 60 years or older (28% [$53813] greater mean resource utilization; P=.005); recipient age of 60 years or older (17% [$32795]; P=.01); alcoholic liver disease (26% [$49596]; P=.002); Child-Pugh class C (41% [$67 658]; P<.001); care from the intensive care unit at time of transplant (42% [$77833]; P<.001); death in the hospital (35% [$67 076]; P<.001); and having multiple liver transplants during the index hospitalization (154% increase [$474 740 vs $186 726 for 1 transplant]; P<.001). Adjusted length of stay and resource utilization also differed significantly among transplant centers.
  
  
  CONCLUSIONS
  Clinical, economic, and ethical dilemmas in liver transplantation are highlighted by these findings. Recipients who were older, had alcoholic liver disease, or were severely ill were the most expensive to treat; this suggests that organ allocation criteria may affect transplant costs. Clinical practices and resource utilization varied considerably among transplant centers; methods to reduce variation in practice patterns, such as clinical guidelines, might lower costs while maintaining quality of care.
authors.affiliation: Department of Medicine, University of California, San Francisco 94143-0936, USA. jas1@itsa.ucsf.edu
authors.forename: J
authors.initials: J
authors.lastname: Showstack
authors.forename: P P
authors.initials: PP
authors.lastname: Katz
authors.forename: J R
authors.initials: JR
authors.lastname: Lake
authors.forename: R S
authors.initials: RS
authors.lastname: Brown
authors.forename: R A
authors.initials: RA
authors.lastname: Dudley
authors.forename: S
authors.initials: S
authors.lastname: Belle
authors.forename: R H
authors.initials: RH
authors.lastname: Wiesner
authors.forename: R K
authors.initials: RK
authors.lastname: Zetterman
authors.forename: J
authors.initials: J
authors.lastname: Everhart
mesh_terms: D000328:Adult; D000367:Age Factors; D002140:California; D005260:Female; D015276:Health Care Rationing; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D017722:Hospital Charges; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D016014:Linear Models; D008107:Liver Diseases / Q000191:economics / Q000601:surgery; D016031:Liver Transplantation / Q000191:economics*; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D015999:Multivariate Analysis; D009329:Nebraska; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D011446:Prospective Studies; D040841:Resource Allocation; D012720:Severity of Illness Index